Final Report

Volume 5
Transforming the system—
innovation and implementation
 Royal Commission into
Victoria’s Mental Health System

Volume 5
Transforming the system—
innovation and implementation

Penny Armytage AM Professor Allan Fels AO

Chair Commissioner

Dr Alex Cockram Professor Bernadette McSherry

Commissioner Commissioner

ORDERED TO BE PUBLISHED

Victorian Government Printer

February 2021

PP No 202, Session 2018–2021 (document 6 of 6)

Volume 5
Transforming the system—
innovation and implementation
ISBN 978-1-925789-73-7 (Print)

Published February 2021

Authorised and published by the Royal Commission into Victoria’s Mental Health System,
Melbourne Victoria.

© State of Victoria, Royal Commission into Victoria’s Mental Health System, February 2021.

Except where otherwise indicated, the images in this publication show models and illustrative
settings only, and do not necessarily depict actual services, facilities or recipients of services.
This publication may contain images of deceased Aboriginal and Torres Strait Islander peoples.

In this document, ‘Aboriginal’ refers to both Aboriginal and Torres Strait Islander people.
‘Indigenous’ or ‘Koori/Koorie’ is retained when part of the title of a report, program or quotation.

ISBN 978-1-925789-74-4 (pdf/online/MS word)

Available at the Royal Commission into Victoria’s Mental Health System website
<www.rcvmhs.vic.gov.au>. If you have any questions about the Commission’s work please
contact the Department of Health <[email protected]>.

ISBN

Summary and recommendations

ISBN 978-1-925789-63-8 (Print) 978-1-925789-64-5 (pdf/online/MS word)

Volume 1: A new approach to mental health and wellbeing in Victoria

ISBN 978-1-925789-65-2 (Print) 978-1-925789-66-9 (pdf/online/MS word)

Volume 2: Collaboration to support good mental health and wellbeing

ISBN 978-1-925789-67-6 (Print) 978-1-925789-68-3 (pdf/online/MS word)

Volume 3: Promoting inclusion and addressing inequities

ISBN 978-1-925789-69-0 (Print) 978-1-925789-70-6 (pdf/online/MS word)

Volume 4: The fundamentals for enduring reform

ISBN 978-1-925789-71-3 (Print) 978-1-925789-72-0 (pdf/online/MS word)

Suggested citation: State of Victoria, Royal Commission into Victoria’s Mental Health System,
Final Report, Volume 5: Transforming the system—innovation and implementation, Parl Paper
No. 202, Session 2018–21 (document 6 of 6).
Volume 5 Front matter

Acknowledgement of​​
Aboriginal land and peoples
The heritage of Aboriginal communities throughout Victoria is vibrant, rich and diverse. We
value these characteristics and consider them a source of strength and opportunity. We
recognise that the leadership of Aboriginal communities and Elders in Victoria is crucial
to improving outcomes for Aboriginal people. Also to be acknowledged, however, are the
devastating impacts and the accumulation of trauma resulting from colonisation, genocide,
the dispossession of land and children, discrimination and racism.

The Royal Commission into Victoria’s Mental Health System proudly acknowledges
Aboriginal people as the First Peoples and Traditional Owners and custodians of the land
and water on which we rely. We acknowledge that Aboriginal communities are steeped in
traditions and customs, and we respect this. We acknowledge the continuing leadership
role of the Aboriginal community in striving to redress inequality and disadvantage, and the
catastrophic and enduring effects of colonisation.

We recognise the diversity of Aboriginal people living throughout Victoria. Although the terms
‘Koorie’ and ‘Koori’ are commonly used to describe Aboriginal people of south-east Australia,
we use the term ‘Aboriginal’ in this report to include all people of Aboriginal and Torres Strait
Islander descent who are living in Victoria. This approach is consistent with the language
conventions of key Victorian frameworks such as the Aboriginal Affairs Framework 2018–2023.

The Royal Commission is conscious that its work is taking place concurrently with renewed
efforts to achieve constitutional recognition of Aboriginal peoples and treaty processes that
are underway in Victoria. We commit to building on this momentum and to ensuring our work
is shaped by the voice of Aboriginal people.

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Volume 5 Front matter

Contents
Acknowledgement of​​Aboriginal land and peoples iii

A note on content x

Terminology and language xi

Personal stories and case studies xiv

Introduction 1

Chapter 34: Integrating digital technology 7

34.1  A digitally integrated mental health and wellbeing system 10

34.2  The potential of technology 14

34.3  Benefits and challenges of digital approaches 24

34.4  The task of digital integration 40

34.5  A statewide approach to building service provider capacity 48

34.6  Better supports that improve equity of access 52

Chapter 35: New approaches to information management 63

35.1  A contemporary approach to information management 67

35.2  Features of contemporary information collection, use and sharing 73

35.3  The challenges of information collection, use and sharing 75

35.4  A pathway forward for information management 96

35.5  Creating a culture of openness and co-ownership 97

35.6  New ICT systems and infrastructure 100

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Royal Commission into Victoria’s Mental Health System

Chapter 36: Research, innovation and system learning 119

36.1  Why an adaptive system is needed 124

36.2  Building an adaptive mental health and wellbeing system for Victoria 128

36.3  An example of innovation and system learning in action 133

36.4  The features of an adaptive mental health and wellbeing system 136

36.5  Strong potential but some missing features 151

36.6  Supporting research, innovation and system learning 165

Chapter 37: Implementation 193

37.1  The work ahead 195

37.2  Requirements for transforming the system 198

37.3  Implementing the reimagined mental health and wellbeing system 225

A note from the CEO 299

A message from the CEO 301

Chapter 38: The establishment of the Commission 307

38.1  Inquiry announced 309

38.2  Interim report delivered 309

38.3  Inquiry extended 309

38.4  Impact of COVID-19 310

38.5  Commissioners appointed 311

38.6  Staff at the Commission 313

38.7  Expert Advisory Committee appointed 315

38.8  Counsel Assisting appointed 316

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Volume 5 Front matter

Chapter 39: The work of the Commission 319

39.1  The Royal Commission 321

39.2  Overview of the Commission’s engagement 322

39.3  Community consultations 326

39.4  Submissions 329

39.5  Site visits 335

39.6  Individual meetings 336

39.7  Public communications 337

39.8  Public hearings 340

39.9  Community sentiment survey 344

39.10  Targeted roundtables 345

39.11  Personal story collection 347

39.12  Interim report 348

39.13  Phase 1 of human-centred design 351

39.14  Collection of witness statements 359

39.15  Panel hearings 361

39.16  Consumer Foundations Working Group 362

39.17  Phase 2 of human-centred design 363

39.18  Targeted roundtables 366

39.19  Workforce survey 369

39.20  Community workshops 370

39.21  Final report 374

39.22  Acknowledgements 375

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Chapter 40: The operations of the Commission  379

40.1  Commission operations 381

40.2  Governance and decision making 382

40.3  Practice directions and protocols 385

40.4  Notices to produce 385

40.5  Finance and procurement 387

40.6  Information technology, records management and data management 389

40.7  People and culture 392

40.8  Office accommodation 395

40.9  Risk management, business continuity and security 395

40.10  Concluding operations 397

Appendices 401

Appendix A.1: Letters patent 403

Appendix A.2: Amended letters patent 411

Appendix B: Data quality statement 413

Appendix C: Consultation and engagement 423

Glossary 474

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Royal Commission into Victoria’s Mental Health System

A note on content
The Royal Commission recognises the strength of people living with mental illness or
psychological distress, families, carers and supporters, and members of the workforce who
have contributed their personal stories and perspectives to this inquiry.

Some of these stories and the Commission’s analysis may contain information that could be
distressing. You may want to consider how and when you read this report.

Aboriginal readers are advised that this report may contain photos, quotations and/or names
of people who are deceased.

If you are upset by any content in this report, or if you or a loved one need support, the
following services are available to support you:

• If you are not in immediate danger but you need help, call NURSE-ON-CALL
on 1300 60 60 24.
• For crisis support, contact Lifeline on 13 11 14.
• For phone-based support contact Beyond Blue on 1300 224 636.
• If you are looking for a mental health service, visit betterhealth.vic.gov.au.
• For situations that are harmful or life-threatening, contact emergency services
immediately on Triple Zero (000).

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Volume 5 Front matter

Terminology and language

Language is powerful and words have various meanings for different people.

There is no single set of definitions used to describe how people experience their mental
health. This diversity is reflected in the many terms used to capture people’s experiences
throughout the evidence put before the Commission.

As stated in the Commission’s interim report, words and language can have a lasting impact
on a person’s life. They can empower and embolden. They can be used to convey hope and
empathy. But they can also be divisive when used to dispossess and divide, and to stigmatise
and label.

The Commission has considered the many perspectives on terminology, and acknowledges
that language can be deeply contested and nuanced. Although it has at all times tried to use
inclusive and respectful language, the Commission is aware that not everyone will agree with
the terminology used.

Another consideration for the Commission has been this report’s broad audience, including
people with lived experience of mental illness or psychological distress, families, carers
and supporters, workers in the mental health system, government and the wider Victorian
community. This diverse audience needs to be able to read the report and understand its
intent at this point in time in the development of the mental health system.

Below is a list of important terms in the report and how the Commission understands them.
This list largely reflects the requirement to align with definitions outlined in the Commission’s
letters patent. It is also consistent with the Commission’s interim report for the purposes
of clarity.

Carer Means a person, including a person under the age of 18 years, who provides
care to another person with whom they are in a relationship of care.

Consumer People who identify as having a living or lived experience of mental illness or
psychological distress, irrespective of whether they have a formal diagnosis,
who have used mental health services and/or received treatment.

Family May refer to family of origin and/or family of choice.

Good mental A state of wellbeing in which a person realises their own abilities, can cope
health with the normal stresses of life, can work productively and is able to make a
contribution to their community.

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Lived People with lived experience identify either as someone who is living with (or
experience has lived with) mental illness or psychological distress, or someone who is
caring for or otherwise supporting (or has cared for or otherwise supported)
a person who is living with (or has lived with) mental illness or psychological
distress. People with lived experience are sometimes referred to as
‘consumers’ or ‘carers’. The Commission acknowledges that the experiences
of consumers and carers are different.

Mental health The Commission outlines in this report its vision for a future mental health
and wellbeing and wellbeing system for Victoria. Mental health and wellbeing does not
system refer simply to the absence of mental illness or psychological distress but
to creating the conditions in which people are supported to achieve their
potential. As part of this approach, the Commission has also purposefully
chosen to focus on the strengths and needs that contribute to people’s
wellbeing. To better reflect international evidence about the need to strike
a balance between hospital-based services and care in the community, the
types of treatment, care and support the future system offers will need to
evolve and be organised differently to provide each person with dependable
access to mental health and wellbeing services and links to other supports
they may seek. The addition of the concept of ‘wellbeing’ represents a
fundamental shift in the role and structure of the system.

Mental A medical condition that is characterised by a significant disturbance of

illness thought, mood, perception or memory.

The Commission uses the above definition of mental illness in line with the
Mental Health Act 2014 (Vic).

However, the Commission recognises the Victorian Mental Illness Awareness

Council Declaration released on 1 November 2019. The declaration notes
that people with lived experience can have varying ways of understanding
the experiences that are often called ‘mental illness’.

It acknowledges that mental illness can be described using terms such as

‘neurodiversity’, ‘emotional distress’, ‘trauma’ and ‘mental health challenges’.

Psychological One measure of poor mental health, which can be described as feelings of
distress tiredness, anxiety, nervousness, hopelessness, depression and sadness. This
is consistent with the definition accepted by the National Mental Health
Commission.

Social and Being resilient, being and feeling culturally safe and connected, having and
emotional realising aspirations, and being satisfied with life. This is consistent with Balit
wellbeing Murrup, Victoria’s Aboriginal social and emotional wellbeing framework.

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Volume 5 Front matter

Treatment, The Commission uses this phrase consistently with its letters patent. This
care phrase has also been a deliberate choice throughout this report to present
and support treatment, care and support as fully integrated, equal parts of the way
people will be supported in the future mental health and wellbeing system. In
particular, wellbeing supports (previously known as ‘psychosocial supports’)
that focus on rehabilitation, wellbeing and community participation will sit
within the core functions of the future system.

The Commission only departs from these terms when referring to specific data sources,
describing research works, or quoting an individual or organisation. The original language
is retained wherever possible to accurately reflect the views and evidence presented to
the Commission. For example, the Commission quotes individuals and organisations that
sometimes refer to ‘mental disorder’, rather than the Commission’s preferred terms of
‘mental illness or psychological distress’. Terms such as ‘disorder’ can be pathologising
and stigmatising, so the Commission only retains them if others use them to convey a
specific meaning.

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Royal Commission into Victoria’s Mental Health System

Personal stories and case studies

Throughout all phases of its work, the Commission has heard from people with lived
experience of mental illness or psychological distress, families, carers and supporters,
members of the workforce, organisations, experts and members of the broader Victorian
community through consultations, submissions, correspondence, public hearings and witness
statements.

Based on these sources, the Commission has included a selection of personal stories that
appear throughout this report. These stories provide the individual’s personal recollections of
their interactions and experiences with Victoria’s mental health system.

The Commission has also included a selection of case studies that are primarily about
services or approaches that illustrate reform opportunities or innovation.

The Commission wanted to consider a broad range of ideas for improving the mental health
system. Therefore, some of these personal stories and case studies include perspectives from
outside of Victoria.

With the permission of the individuals involved, these have been modified for privacy and
confidentiality where appropriate. In some instances, the Commission has also made
non‑publication orders to protect privacy and confidentiality.

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Volume 5 Introduction

Introduction

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Royal Commission into Victoria’s Mental Health System

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Volume 5 Introduction

As required by the Commission’s letters patent, the Commission was a policy‑based inquiry.
This report presents the findings from this process and sets out recommendations to inform
the design of a new mental health and wellbeing system.

The Victorian community made more than 12,500 contributions to inform the Commission’s
work. The Commission has listened to this diversity of voices and analysed a wide variety of
data and research. These inputs have illustrated the factors that shape people’s experiences
of mental health and wellbeing and have formed the basis for the design of the future system
and services.

Volume 1 of this report outlines a new approach to providing Victorians with the right mental
health treatment, care and support at the right time, and in the right places across the state.
Volume 2 describes the collaboration needed to support good mental health and wellbeing.
Volume 3 outlines reforms to promote inclusion and address inequities in the mental health
system. Volume 4 explains the features that will ensure the system provides high‑quality and
safe services.

This volume starts by looking forward, outlining how the system will continue to be
transformed. It sets out the technology, information and expertise required for a contemporary
system, and how it will drive continuous improvement. It also details considerations for
implementing the Commission’s recommendations and proposes a 10‑year implementation
agenda that comprises three waves of reform. The volume concludes by looking back at the
work and processes of the Commission itself.

Transformation through digital technology and

new approaches to information management
The reformed mental health and wellbeing system will provide consumers with more opportunity
to lead and actively participate in their own care and receive safe and effective treatment, care
and support, supported by high‑quality, easily accessible digital technology and information.

Harnessing the power of technology will be critical to providing a connected and accessible
mental health and wellbeing system for consumers, families, carers and supporters. As
outlined in Chapter 34: Integrating digital technology, a contemporary mental health and
wellbeing system should use the latest technologies to offer people access to the full range of
services and support available and help them navigate options so they receive continuity of
care. It should recognise diversity and allow people to access flexible, personalised supports,
regardless of where they live, the language they speak, their identity or their background.

Contemporary approaches to collecting, using and sharing information—with the needs

and preferences of the consumers always in mind—will be a bedrock for an increasingly
person‑centred system.

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Royal Commission into Victoria’s Mental Health System

State‑of‑the‑art technology and information systems will ensure organisations and

individuals have access to the information they need—and when they need it—to deliver
seamless and effective treatment, care and support. New information cultures and processes
will strongly protect consumers’ information and privacy and promote trust in information
sharing. New information systems and architecture will assist mental health professionals
across the state to undertake their work, and to provide consumers with ways to view and
contribute to records created about them. Data repositories and clinical registries will
support research, outcome measurement and system accountability. Refer to Chapter 35:
New approaches to information management for details.

Innovation, continuous learning and improvement

The new system must be set up to learn, develop and respond to changing needs and
unexpected events—just as it has adapted in response to the COVID‑19 pandemic.

The Collaborative Centre for Mental Health and Wellbeing will be the heart of this constantly
learning and improving system. Drawing together expertise from across Victoria and around
the world, the centre will research, develop and disseminate effective practice to effect
large‑scale positive changes across the system. It will translate cutting‑edge research into
practice through disseminating knowledge and research, and through providing treatment,
care and support across the state.

Dedicated funding and support for innovation will encourage consumers, people working in
the system, investors and entrepreneurs to try new approaches to providing services. The
Department of Health will systematically require and support the evaluation of emerging
innovations and established programs. It will use findings from research and practice to make
evidence‑informed approaches widely available. Refer to Chapter 36: Research, innovation
and system learning for details.

Realising system reform

Despite the best endeavours of many, previous efforts to reform the Victorian mental health
system have failed to deliver what the Victorian community deserves. This Commission
carries the weight of unrealised hopes and expectations accumulated over decades. This
time must be different— the results of this inquiry must lead to transformational change.

The changes described in this report are enormous and touch every part of the system.
Transformation will take strong leadership, courage and collaborative effort from all partners
involved in the delivery of reform over many years.

The Commission has considered the task that lies ahead for implementers and has tried to
make practical recommendations, anticipate implementation challenges, and consider how
to prioritise the work ahead.

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Volume 5 Introduction

Chapter 37: Implementation aims to help prepare the Victorian Government and all partners
involved in implementation for success by exploring the requirements needed for enduring
and profound change across Victoria’s mental health system—as well as potential pitfalls. It
also proposes a 10‑year implementation agenda that comprises three waves of reform. This
plan must adapt and evolve with the changing environment in which implementation will take
place. Victorians need to be confident that the government will stay true to the Commission’s
aspirations and make the hopes of people with lived experience of mental illness or
psychological distress, families, carers and supporters a reality.

Recent experiences have demonstrated the willingness and determination of people

committed to the good mental health and wellbeing of the Victorian community to work
together, overcome adversity and find new ways of providing treatment, care and support.
This is the spirit and energy that will deliver the vision of the Commission and transform
Victoria’s mental health system so it is equipped to meet the needs of people both now and
into the future.

The Commission’s work

This volume concludes by reporting on the operations of the Commission under the Inquiries
Act 2014 (Vic) and provides details about its engagement approach, including its changed
ways of working as a result of the COVID‑19 pandemic.

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Royal Commission into Victoria’s Mental Health System

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Volume 5 Chapter 34: Integrating digital technology

Chapter 34

Integrating digital
technology

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Royal Commission into Victoria’s Mental Health System

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Volume 5 Chapter 34: Integrating digital technology

Recommendation 60:

Building a contemporary system

through digital technology
The Royal Commission recommends that the Victorian Government:

1. d
evelop new statewide digital service requirements for all publicly funded mental
health and wellbeing service providers that outline the consistent minimum digital
functionality every provider should offer to consumers, families, carers and supporters.
2. s
upport mental health and wellbeing service providers to adopt digital technologies,
where safe and appropriate to do so, through:

a. developing regulatory arrangements;

b. providing funding; and
c. b
uilding the ability of mental health and wellbeing service providers to integrate
digital technologies.

3. e
nable mental health and wellbeing services to offer people living with mental illness or
psychological distress access to devices, data and digital literacy support, where it is
their preference to use digital services but they are otherwise unable to do so.

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Royal Commission into Victoria’s Mental Health System

34.1  A digitally integrated mental

health and wellbeing system
Contemporary service delivery is central to the Commission’s vision for the future Victorian
mental health and wellbeing system. All Victorians have the right to treatment, care and
support that responds to their needs.

The Victorian mental health and wellbeing system needs to deliver services in responsive,
compassionate, flexible and collaborative ways to give people the support they need,
when it is needed. New service offerings where providers work collaboratively to support
a consumer’s needs will help to achieve this goal. New planning approaches will ensure
environments, both physical and virtual, are inclusive, modern and welcoming. New skills and
approaches to practice will enable services to provide people tailored treatment, care and
support, regardless of their needs.

The system will also draw on, develop and test new ideas and evidence to determine what is
working and what can be improved. Delivering this mental health and wellbeing system requires
policy settings and service features that are designed with consumers, families, carers and
supporters.

The Commission’s interim report recognised that technological advancements offer the
potential to reimagine service access and delivery.1 Adopting digital technologies across
the health system is recognised as an important tool to help achieve more person‑centred
health and wellbeing support,2 high‑quality care3 and service delivery that focuses on early
intervention and coordinated care.4 Harnessing the power of technology will be critical to
providing a connected and accessible mental health and wellbeing system that promotes
continuity of treatment, care and support for consumers, families, carers and supporters.

While there has been growing support for using technology to address some of health’s
biggest challenges—such as increasing service demand, rising costs and shifting
workforce and consumer expectations5—its uptake in mental health, both in Australia and
internationally, has been limited.6 The COVID‑19 pandemic has sped up the adoption of some
forms of technology,7 but there are opportunities to build service delivery innovation and
improve the way services are accessed and experienced by consumers.8

A contemporary mental health and wellbeing system should use the latest technologies
to offer people access to the full range of services and support available and help them
navigate options so they receive continuity of treatment, care and support. It should
recognise diversity and allow people to access flexible, personalised supports, regardless of
where they live, the language they speak, their identity or their background.

As described in Chapter 6: The pillars of the new system—community‑based mental health

and wellbeing services, the Commission is recommending that in order to respond to the
needs of consumers across Victoria, community mental health and wellbeing services will be
expected to offer treatment, care and support across the core functions through a range of
delivery modes, including digital modes.

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Volume 5 Chapter 34: Integrating digital technology

These core functions are described in Chapter 7: Integrated treatment, care and support in
the community for adults and older adults, Chapter 12: Supporting perinatal, infant, child
and family mental health and wellbeing, and Chapter 13: Supporting the mental health and
wellbeing of young people.

People should have information at their fingertips and choice in the ways they receive
treatment, care and support, whether it be face‑to‑face, or through telehealth, text, email
or online. Automated referrals and online booking functions should simplify navigation and
movement between services, and there should be greater access to blended care, which
is discussed in more detail in Box 34.1. These things should be routinely available to people
while maintaining the highest standards of quality, trust, safety and human rights. Of course,
digital service delivery may not be the preference of every individual, nor appropriate
or accessible to all consumers. A range of service options and modes should always be
available, to ensure that no one is left behind.

Figure 34.1 outlines the Commission’s vision for a digitally integrated mental health and
wellbeing system. The Commission expects that new digital technologies will emerge, and will
continue to change the services and supports on offer. Because of this, the system will need
to be adaptable.

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Figure 34.1:  The Commission’s vision for a digitally integrated mental health and wellbeing system

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Volume 5 Chapter 34: Integrating digital technology

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Royal Commission into Victoria’s Mental Health System

34.2  The potential of technology

Digital technologies are already having a significant impact on people’s expectations of how
they receive treatment, care and support, and the ways in which services are delivered, both
in everyday life and in health care.9

One roundtable participant told the Commission that people are shifting to accessing
support online, particularly where they may have previously had negative experiences of
accessing face‑to‑face treatment, care and support:

I just think more people access things online, more people don’t want to go into a
hospital, especially if they’ve had negative experiences … you’ve got to have options
available to people.10

Associate Professor Simon Stafrace, Chief Adviser at Mental Health Reform Victoria, said in
a personal capacity that digital technologies have the potential to markedly transform the
mental health system:

I have little doubt that in time, digital technologies will create a new paradigm [model]
for mental health services that will transform the ways in which treatment is delivered,
information is shared and recorded, and the workforce is recruited, trained and
developed.11

There are already numerous and diverse digital tools and interventions being used within and
outside of the public mental health system, and digital technologies are changing quickly.

Interventions include the use of telehealth (telephone and videoconferencing) to deliver

treatment, care and support, supported online courses and therapies, self‑help apps,
gamification (making tasks into games) and digital assessments.12 Tools include wearables
to monitor health, track activity and support progress, websites to provide quick and easy
access to information, electronic records, automated services such as e‑bookings and
e‑referrals, and a host of other technologies.13

Box 34.1 summarises some of the most well‑known digital interventions and tools, as well as
the major terms used to describe digital technology in mental health.

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Volume 5 Chapter 34: Integrating digital technology

Box 34.1:  Key terms for digital mental health technologies

The terminology used to describe the use of technology in health and mental
health care varies. The Commission considers that ’digital mental health
technology’ refers to the use of online and other digital technologies to improve
mental health and wellbeing, including access to information, service delivery,
education and wellbeing promotion.

It encompasses a vast range of technologies, including apps, portals, social

media, smartphones, augmented or virtual reality, wearables and activity
tracking, e‑referral, notifications and artificial intelligence. Other common
terminology includes ‘e‑mental health’ (health services that are online), ‘m‑health’
(mobile and app‑based support) and ‘virtual health’.14

This report uses ‘digital mental health technology’ as an overarching term that
encompasses many types of technology. Where relevant, however, the report
names specific technologies. Some of the major technologies used in the sector
are described below.

Telehealth—video teleconferencing using some form of online software or

phone‑conferencing to deliver services and supports directly to a consumer.15

Supported digital services—online courses and programs that are clinician

supported.16 They usually provide some form of low‑intensity cognitive
behaviour therapy.17 For example, THIS WAY UP is a university‑developed and
Commonwealth‑funded online program offering cognitive behaviour therapy
courses for people with depression and anxiety.18

Self‑help supports—smartphone apps and online programs that help consumers

self‑assess and monitor their health, and manage their symptoms and treatment,
and that provide them with information.19 Examples of self‑help supports include
Smiling Mind, a meditation and mindfulness app and website, and the Calm
app, which helps with sleep and meditation.20 Other examples include the IMood
Journal and Recovery Record, which support a person to track their mood and
any changes in their mental health, and to help identify triggers, coping strategies
and when they may need to seek extra help.21

Text and chat‑based support—the use of text (phone) and chat (web) channels
to communicate with a service or support person.22 This can be in real time,
where both people communicate at the same time, or it can be asynchronous; for
example, the consumer leaves a message and a support person responds later.
One example is the Crisis Text Line in the United States.23 Consumers in crisis can
access free, 24/7 support. They text the supplied number and can exchange texts
with a trained crisis counsellor.24

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Royal Commission into Victoria’s Mental Health System

Blended care—providing treatment, care and support through integrating

digital and face‑to‑face supports. In blended care, digital supports are used
to complement face‑to‑face services and build on the gains achieved in
face‑to‑face delivery.25

E‑referral—automated electronic service referrals between providers.26

E‑notification—electronic notifications to remind people they have a booking, or

to let providers know a new referral has been sent.27

E‑bookings—a technology that allows consumers or service providers to

electronically select and book appointments.28

Websites—online mental health website pages that provide information, links

and supports.

Social media—includes online peer or service‑led forums and information that

is delivered through a wide range of existing social media platforms (such as
Facebook, Twitter, YouTube, Instagram and WeChat).

Virtual assistants (chatbots)—digital tools that assist people to navigate and

find the information they need to manage their mental health.29 Most virtual
assistants are programmed to lead consumers through pre‑set options based
on the consumer’s responses. For example, Sam the Chatbot is used on the
Commonwealth Head to Health website to help people have an interactive
discussion by entering information about their concerns.30 More advanced
chatbots that can have in‑depth conversations with people about their mental
health are being tested, but their effectiveness is still being evaluated.31

Artificial intelligence (AI)—the use of computer techniques in online therapy,

diagnosis and monitoring to help improve outcomes and experiences.32 AI is
usually used as a tool that has the ability to quickly learn, adjust and change
based on experiences, and to use that information to help people make decisions
about services.33

Virtual or augmented reality (VR)—VR creates digitally generated worlds that the
user experiences through a digital device (such as a headset). In mental health,
VR is mostly being used as an aid to help clinicians to coach people through
difficult scenarios (such as phobias, social anxiety or post‑traumatic stress
disorder), and to help them adjust their behaviour and build coping strategies
that they can apply in real‑world settings.34

Language and accessibility support—accessibility features that improve people’s

ability to engage with information or supports such as telehealth to support
language interpretation,35 digital translation and assistive technology to help
people with disabilities access services.

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Wearables—electronic devices that consumers can wear, like activity trackers

and smartwatches, designed to collect data about users’ personal health or social
activity.36

Consumer records—electronic records that are used to assist the documentation

of, and communication about, a consumer’s treatment, care and support.37 Some
electronic records allow sharing of relevant consumer health information between
a range of providers involved in a person’s treatment, care and support (such as
My Health Record), subject to consumer consent and privacy principles.38

Collaboration platforms and portals—programs and digital platforms that allow

people to work together virtually, or to access information and participate in
their treatment, care and support. For example, the United Kingdom is trialling
an electronic records and communication system called Healthlocker. 39 It allows
consumers to send confidential and secure messages to their treatment, care and
support teams, access their care plans, manage goals, and access and create
coping strategies.40

As noted above, digital technologies and interventions have a range of uses. Dr Piers Gooding,
Research Fellow at the Melbourne Social Equity Institute and the University of Melbourne
Law School, told the Commission in a personal capacity that technologies in mental health
services can be used for many purposes, including:

• to provide information and knowledge

• communication
• to deliver therapies and treatments
• to monitor consumer progress
• wellbeing and outcomes
• to support consumer movement and transitions between and within services
• to support collaboration and decision making between providers, consumers, families,
carers and supporters.41

Figure 34.2 summarises some of the main technologies and their uses.

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Royal Commission into Victoria’s Mental Health System

Figure 34.2:  Major digital mental health technologies and their primary purpose

Source: Witness Statement of Dr Piers Gooding, 25 June 2020, paras. 18 (a–g); Piers Gooding, ‘Mapping the rise of
digital mental health technologies: emerging issues for law and society’, International Journal of Law and Psychiatry,
67 (2019), 1–11.

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34.2.1  Growth of digital technologies in mental health

There is a push to digitise and modernise many mental health and wellbeing services and
supports in response to consumer needs and preferences.42 However, it is not entirely clear to
what extent digital technologies are currently being used in mental health.43 This information
gap makes it difficult to determine the outcomes that digital technologies are producing
overall.44 Despite this gap, there are numerous examples of how digital technologies are being
applied in mental health.

Helplines such as Beyond Blue,45 Lifeline46 and Suicide Call Back now offer, or are moving to
offer, multichannel and flexible access to support through text and web‑based chat services.
Ms Georgie Harman, CEO of Beyond Blue said that digital technology is shifting the way
information is accessed by consumers and is enhancing choice. This has changed the way
Beyond Blue responds to people.

The digital revolution has shifted the way in which information is created, received,
collected and shared. It has also enhanced the ways people can interact with each
other and broader communities, with a potential 24‑hour cycle of connectivity and more
consumer choice than ever. These trends have changed how Beyond Blue reaches out to
support people, how they reach out to us, and how they interact with each other.47

Beyond Blue is now implementing a new three‑year strategy using technology to create an
integrated online platform that offers consumers personalised experiences through a range
of channels informed by consumer preference.48

Outside of the public mental health system, many digital mental health services have
emerged in response to consumer needs and preferences, and they are gaining popularity.
The Black Dog Institute, which specialises in digital mental health interventions for anxiety
and depression, stated that there is growing use of and support for digital self‑help tools,
especially among people experiencing mild to moderate forms of depression and anxiety.49
The uptake of these supports has increased significantly during the COVID‑19 pandemic.

Dr Hila Haskelberg, Program Manager of THIS WAY UP at St Vincent’s Public Hospital Sydney,
told the Commission in a personal capacity that THIS WAY UP made its online courses
available directly to the public in 2015 in response to consumer demand for online delivery.50
Since the COVID‑19 pandemic, THIS WAY UP has experienced a 600 per cent increase in
the number of clinicians registering consumers to use their online courses and a 700 per
cent increase in the number of people accessing the courses.51 The organisation recently
partnered with Bupa Australia to give more people access to the program.52

Dr Addie Wootten, CEO of the widely used mindfulness app Smiling Mind, told the Commission
that since the COVID‑19 pandemic began the app has seen a 165 per cent increase in
downloads and a 367 per cent increase in monthly active users.53 The app is especially
popular with young people and is now used by one‑third of Australian educators in the
classroom, as well as by 50,000 participants in workplaces nationally.54

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Royal Commission into Victoria’s Mental Health System

Large technology companies are also increasingly investing in early intervention in poor
mental health.55 During a roundtable, some companies noted that the internet is often the
first place people go when seeking information on mental health or services (such as through
online searches or forums). They indicated that this means online platforms provide a unique
opportunity to engage with people early and to help them access the right treatment, care
and support.56

One example is Twitter, which has partnered with Lifeline to offer the #ThereIsHelp
notification service, which provides people with mental health resources, and encourages
them to reach out and seek help when needed.57 Twitter has also supported Lifeline to launch
the #BeaLifeline direct message chatbot. The chatbot helps families, carers and supporters
to easily discover Lifeline’s resources, seek advice, or to discreetly request professional phone
or text support in times of need.58

Recent research has shown that as many as 80 per cent of young people would like to
receive support from mental health professionals via social media in the future, and others
may prefer to use online forums or blogs, indicating that social media platforms could be an
important avenue to support future service delivery.59

Advocacy organisations and groups are increasingly using digital technologies to improve
people’s understanding of their rights through the interactive provision of support tools and
resources. For example, Independent Mental Health Advocacy has co‑produced a self‑help
tool for people who want information and support to exercise their rights when they are
receiving compulsory treatment.60

Digital channels are also increasing the reach of peer support networks, and offer consumers
greatly expanded peer support options.61 One example is the online peer support initiative,
the Big Feels Club. The Big Feels Club offers support to people experiencing psychological
distress through online forums, podcasts, articles and sometimes face‑to‑face meet‑ups.62

Mr Graham Panther, a witness before the Commission and co‑founder of the Big Feels Club,
told the Commission that he and his co‑founder, Ms Honor Eastly, established the platform to
give people somewhere to go and hear from people like themselves, creating a community of
people with similar experiences to support one another.63

The Big Feels Club’s podcasts, online articles and online community are providing new forms
of support that are not available anywhere else in Victoria.64 Mr Panther noted that The Big
Feels Club has amassed nearly 6,000 community members, and its articles and podcasts
have been downloaded more than one million times.65 The growing use of these types of
supports indicates they are meeting a consumer need.

Within public health and mental health services, technologies such as telehealth (phone and
videoconferencing) and websites are now becoming commonplace and are embedded within
service delivery. These interventions have a strong evidence base and are being implemented
by government‑funded services.66

Since early 2020 the adoption of digital technologies has rapidly grown in response to the
COVID‑19 pandemic.67 Associate Professor Stafrace said that in mid‑2020, 40–100 per cent of
private psychiatrists’ work was being conducted using telehealth.68

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Area mental health services have transitioned to using telehealth for much of their
community service delivery.69 Ms Kym Peake, then Secretary of the former Department of
Health and Human Services, said that in April 2019, area mental health services had only
delivered 346 consumer contacts via teleconference. In April 2020 this number increased to
more than 10,000 consumer contacts.70 Ms Peake noted that, where appropriate, telehealth
is being used for triage, screening, assessment and some aspects of community‑based
treatment.71

The Commission understands that the COVID‑19 pandemic has resulted in a shift in mode of
contact with consumers. While face‑to‑face contacts reduced between March and June 2020
compared with the same time in 2019, telephone and telehealth (video) increased.72 Figure
34.3 shows the rapid growth in telehealth use in community mental health services since the
start of 2020 and compared with 2019 levels. The growth was mostly caused by the impact
of the COVID‑19 pandemic, but it indicates that some people were able to use telehealth to
access treatment, care and support, though further work is needed to understand people’s
preferences.

Telehealth is also allowing for more contacts and flexibility, and improved administrative
productivity. Mr Angus Clelland, CEO of Mental Health Victoria, noted that online and phone
delivery has allowed services to offer consumers flexible options, such as substituting four
30‑minute video sessions for a two‑hour, face‑to‑face session.73 This approach has allowed
consumers to keep regular contact but also allowed mental health workers to provide
support to more people.74 Ms Peake noted that services are introducing innovative new ways
of working, including through online clinics and the provision of virtual subacute care, as
opposed to bed‑based services.75

Figure 34.3:  Number of community contacts by videoconference or teleconference, by month,

Victoria, 2019–20

Source: Department of Health and Human Services, Client Management Interface/Operational Data Store, 2019–20.
Note: Includes contacts where the patient is not present. Other mode category not displayed.

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Royal Commission into Victoria’s Mental Health System

Other digital interventions, such as AI‑programmed chatbots, wearables and blended

therapeutic care, are still emerging in Victoria but are growing in prominence. The uptake is
stronger in private settings—governments are currently slower to implement these newer
technologies.76 While they hold promise, the evidence base for these digital interventions is
more limited, and there are risks in investing public money in unproven interventions.77

The Commission supports the statewide adoption of established and evidence‑based

technologies such as telehealth, evidence‑based online services and multichannel access to
services. However, it is mindful that other technologies and interventions are still emerging
and need further evidence before they can be rolled out statewide.

The digital revolution is one of the biggest forces transforming the ways in which we as a
society interact with one another and is reshaping systems globally and locally.78 The rapid
pace of change generated by the digital revolution influences how people communicate, find
and receive information, and how they engage with services.79 For example, social media
platforms such as Facebook and Twitter only emerged in the early 2000s, but social media
is now used by just over 70 per cent of the Australian population.80 This pace of change
continues to grow and move quickly, and so do advancements and opportunities in the digital
mental health space, particularly through collaboration with industries.

Given the rapid pace of change in digital technologies, there will be a need for the Victorian
Government to closely monitor new and emerging digital technologies and services and build
strategies to leverage innovation to improve mental health and wellbeing outcomes. This
should include testing new approaches and assessing their impact through partnerships with
consumers, academics, the private sector and service providers.81 This evidence base can
then support future investment in technologies and services that will have the biggest impact
on improving outcomes.82

Figure 34.4 outlines the Commission’s assessment of the maturity of major digital
technologies that may transform the mental health and wellbeing system—that is, how far
progressed they are from ‘being tested’ to ‘established’ and supported by evidence. As the
figure shows, some technologies require more research and evaluation to understand their
potential impacts, benefits and risks for consumers and services, but given the speed at
which technologies are evolving it can be difficult to predict trends.83

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Figure 34.4:  Digital mental health technologies maturity scale

Sources: RCVMHS assessment derived from a range of sources including Witness Statement of Dr Piers Gooding, 25
June 2020, para. 32 (d); Gerhard Andersson and others, ‘Internet-delivered Psychological Treatments: From Innovation
to Implementation’, World Psychiatry, 18.1 (2019), 20–28 (p. 20); Simon Leigh and Steve Flatt, ‘App-Based Psychological
Interventions: Friend or Foe?’, Evidence Based Mental Health, 18.4 (2015), 97–99 (p. 97); Mario Alvarez-Jimenez and
others, ‘HORYZONS Trial: Protocol for a Randomised Controlled Trial of a Moderated Online Social Therapy to Maintain
Treatment Effects from First-Episode Psychosis Services’, BMJ Open, 9.2 (2019); Ian B Hickie and others, ‘Practitioner-
supported Delivery of Internet-based Cognitive Behaviour Therapy: Evaluation of the Feasibility of Conducting a
Cluster Randomised Trial’, Medical Journal of Australia, 192.S11 (2010), S31–35; Laura Martinengo and others, ‘Suicide
Prevention and Depression Apps’ Suicide Risk Assessment and Management: A Systematic Assessment of Adherence
to Clinical Guidelines’, BMC Medicine, 17:231 (2019); Michelle Burke Parish and others, ‘Managing Psychiatrist-Patient
Relationships in the Digital Age: A Summary Review of the Impact of Technology-Enabled Care on Clinical Processes
and Rapport’, Current Psychiatry Reports, 19.11 (2017).

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Royal Commission into Victoria’s Mental Health System

34.3  Benefits and challenges

of digital approaches
Consumers, families, carers and supporters have indicated that digital mental health
technologies can have many benefits if they are integrated into the system effectively and
in ways that enhance other service offerings.

Individual expectations will always differ, but generally speaking, the Commission has
been told that consumers expect and want technology to be used in ways that improve
their service experience and the quality of services, make services more accessible and
personalised, and give them more choice.

Mr Dave Peters, a witness before the Commission, noted that digital technology can play a
number of roles in improving consumer access to treatment, care and support, supporting
consumer wellbeing, improving face‑to‑face service delivery and monitoring service
performance:

Digital technology can play a massive role in terms of enhancing face‑to‑face support.
For example, it can act as a benchmarking tool to monitor progress, or as an activity
diary to record exercise. I believe technology can play a huge role in supporting people
to pursue their wellbeing. It is also useful for people in remote areas, where there may
be a lack of face‑to‑face support and other options. It can also be useful for people
experiencing domestic and family violence, where meeting face to face could be
difficult, as well as for people who don’t feel they can talk openly about these issues with
or in front of their family—a text message or email can be done privately, even in the
same room as other family members.84

While consumers can see the benefits of technology, they were clear that they want
technology to improve and build on face‑to‑face services to make them more accessible,
effective and personalised, rather than to replace the in‑person human element of care.85
As Mr Peters noted:

These technological tools can provide amazing access to support, but I want to
emphasise that technology will never be a replacement for human contact and
connectedness with a real person.86

Mr Al Gabb, a witness before the Commission, said he still preferred one‑on‑one contact with
a person, despite the benefits of interventions such as telehealth.

I think it’s definitely got merit. There’s some people that live far more remote than I
do, but I don’t think it’s the silver bullet. I think, you can’t go past one‑on‑one contact
as a human.87

Some consumers may be unable to use digital services (either completely or partially) for
a range of reasons. While it can have benefits for some people, others may find the mode
distressing or difficult to use.

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Figure 34.5:  Consumer expectations of digital technologies in mental health

Sources: RCVMHS, Young people Human Centred Design Focus Group, Record of Proceedings, 2020; RCVMHS,
Information sharing Human Centred Design Focus Group, Record of Proceedings, 2020; Witness Statement of Dave
Peters, 22 July 2020.

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Royal Commission into Victoria’s Mental Health System

The effectiveness of digital technologies in mental health services is difficult to measure,

and the impact they have on the quality of services requires more research.88 On the whole,
many evidence‑based digital technologies appear to perform well against the domains of
high‑quality care, including effectiveness, safety, appropriateness and continuity of care.89

People also need to know that the technology will protect their privacy, safety and rights.
They want to be able to trust it.90 The Commission has heard from several consumers
of mental health services about their expectations of digital technologies. Figure 34.5
summarises some of the major features that consumers expect from these technologies, and
why these features are important to them.

In general, digital technologies have the potential to improve quality and effectiveness
through providing more intensive, personalised and data‑informed treatment.91 Digital
technologies may be more appropriate or preferred by some consumers because they
offer flexibility, choice and tailored content. They can also offer more connected treatment,
care and support through providing treatment in between face‑to‑face sessions, helping
consumers to manage their mental health and stay well.92

The Commission has not evaluated the effectiveness of individual digital interventions but
understands that some supported online interventions have been shown to be as effective
as their face‑to‑face counterparts.93 Feedback on the use of telehealth indicates that some
consumers are receiving the same level of service as in their face‑to‑face sessions.94 However,
the Commission understands that experiences are highly personalised. Dr Elizabeth Deveny,
CEO of South Eastern Melbourne Primary Health Network, noted that ‘[s]ome consumers
are enjoying the use of digital technologies to mediate clinical sessions, while others have
expressed dissatisfaction with the loss of face‑to‑face sessions.’95

Overall, there is evidence indicating that digital technology can benefit consumers, families,
carers and supporters, service providers and the system in many ways.

34.3.1  Improved information and service navigation

Centralised, well‑maintained and user‑friendly online information can improve people’s
access to information, increase awareness of services and give people more agency—that
is, a sense of control over what happens to them.96 As Professor Mario Alvarez‑Jimenez,
Director of Orygen Digital, observed, ‘it is important that people are in the driver’s seat [of
their care] and that through technology they can … understand the pros and cons of different
alternatives’.97

People appear to be taking advantage of online health information. Research by the Black
Dog Institute indicated that people often seek help via digital and online platforms, and some
people prefer to find information through these channels.98

The Commission’s 2019 Community Sentiment Survey found that websites were a popular
source of information for people facing a mental health challenge, with young people being
most likely to seek information online in the first instance, as shown in Figure 34.6. ReachOut,
an online mental health service provider for young people and their parents, also noted that
young people are increasingly dependent on the internet for information.99

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Figure 34.6:  Where people go to seek information when facing a mental health challenge, by
age group, Victoria, 2019

Source: RCVMHS, Community Sentiment Survey-Key findings, November 2019.

The Commission was told that access to high‑quality online information and navigation tools
is critical to help people manage their own mental health, understand the system and make
informed choices about which services they should use.

One person told the Commission that well‑designed websites can make information easily
accessible to people:

Everybody is saying the same thing—it’s hard to find services. There needs to be a
website for people to just click on ‘access’ and all the phone numbers are there. Make it
available and easily accessible.100

Ms Harman also said that digital tools help people access trusted information without having
to rely on service providers for advice.101 This builds people’s sense of agency and their ability
to manage their own needs, where appropriate.

The Productivity Commission Mental Health Inquiry Report recognised the value of digital
platforms to provide people with better access to information, to help them navigate between
services.102 It recommended developing a new national digital mental health platform that
provides people with comprehensive information on mental health and services, online
assessment and referral tools, access to supported digital interventions, and a gateway to a
range of digital and face‑to‑face supports.103

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Royal Commission into Victoria’s Mental Health System

Chapter 8: Finding and accessing treatment, care and support recommends creating a new
state website for mental health and wellbeing services that will help consumers, families,
carers and supporters to easily find the right services to meet their needs.

Digital technologies can also help people find their way through the system. Once people
have found the information they need and sought help, online bookings, e‑referrals and text
notifications can provide better continuity of care and more streamlined service experiences.104

34.3.2  Expanded access and support

Digital mental health services can provide greater access to more personalised and flexible
support for many people living with mental illness or psychological distress. There are real
opportunities to use digital technologies to make a marked improvement in service access for
specific cohorts and communities that are struggling to receive treatment, care and support.

Using telehealth to reach more people who struggle to access treatment,

care and support

Delivering psychological or psychiatric treatments through telehealth could help ensure more
people can access the services they need, when they need them. Telehealth has been shown
to be just as effective as face‑to‑face service delivery for many consumers.105

One of the major benefits of telehealth is its ability to break down geographic barriers.106
In regional Victoria, telehealth is providing access to services where they otherwise don’t
exist.107 Workforce shortages in rural and regional areas significantly affect rural and
regional Victorians’ ability to access specialist services.108 The use of telehealth is allowing
more consumers to access specialist support, even when the service may not exist in their
local area.

One person submitted to the Commission that access to telehealth services provided critical
support when there was little else available in her area:

I live in a regional area … and struggled to see any therapists, telehealth services
is what saved me.109

Mr Trevor Thomas, a witness before the Commission, also stated that telehealth had allowed
him to skip the waiting list and see a psychiatrist in another state, who now works with his
local GP to provide the services he needs:

I tried to get in to see a psychiatrist, and I was told that it was a [3] month wait. There
just doesn’t seem to be enough psychiatrists around. My GP said to me he would
organise for me to see a psychiatrist through telehealth. So within [3] weeks I saw a
psychiatrist in Sydney. My GP clinic set me up with a laptop and I spent 40 minutes
talking to him. I clicked with him. He now is changing my medication. I am on a mental
health plan, and currently using my sessions to see the Sydney psychiatrist via
telehealth. The psychiatrist shares his notes with my local GP and so I feel like they are
working together to help me.110

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Digital technologies such as telehealth also provide more opportunities for collaboration
between service providers in regional/remote areas and those in metropolitan areas.111 This
can improve access to multidisciplinary care teams and consultation liaison, which is critical
for people with more complex needs.

As one example, Professor Ravi Bhat, Divisional Clinical Director of Goulburn Valley Area
Mental Health Service, Goulburn Valley Health, told the Commission that Goulburn Valley
Health has introduced Project Echo, a videoconferencing program that allows primary
care teams and specialists to work together virtually to support a consumer, without them
having to travel to a metropolitan area to see the specialist.112 A recent systematic review of
Project Echo found it to be effective at increasing provider knowledge of mental health and
consumer access to services in remote locations.113

While telehealth has historically benefited regional areas, its value is also recognised more
broadly.114 It can provide an accessible means of service delivery for people who have other
commitments, who have limited access to transport, or who may find it difficult to leave their
property due to mobility issues, disability or caring duties. One person submitted that there
are benefits of telehealth for people in both regional and city areas:

Telehealth will be a great addition to mental health in both regional and city areas,
giving people access to help without leaving home.115

Another person submitted that having the ability to access online support groups would
greatly improve their ability to use these types of resources, without affecting their ability to
undertake their caring role:

I often can’t attend support groups … because I’m trying to single parent and work and
get better. If I could access these via audio/video conferencing I could still attend when
my kids are in bed, which would really help and also limit the isolation I experience
having no family around.116

In early 2020 in response to the COVID‑19 pandemic, the Medicare Benefits Schedule was
expanded to include national coverage of telehealth services for mental health services.117
This has further demonstrated the potential of telehealth to provide greater access to
services for people in metropolitan and regional areas. Since March 2020, Medicare funded
telehealth consultations for mental health has continued to increase. In June 2020, national
telehealth consultations for mental health services totalled 372,000, compared with only
56,000 in March 2020.118

Victoria has experienced similar growth in the use of telehealth for delivering mental health
and allied health services. Figure 34.7 shows that between March 2020 and September 2020
the use of telehealth rose significantly for a number of services including GPs, psychologists
and clinical psychologists. While use is still high, the Commission notes that telehealth use
has declined slightly between September and October 2020.119

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Royal Commission into Victoria’s Mental Health System

Figure 34.7:  Number of COVID-19 Temporary Medicare Benefits Schedule telehealth items
processed, by occupation, Victoria, March and September 2020

Source: Australian Government Services Australia, Medicare Statistics: Medicare Item Reports, <www.
medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp>, [accessed 14 November 2020].
Note: COVID-19 – Temporary Medical Benefits Schedule telehealth items: General practitioner telehealth items—92112,
92113, 92114, 92115, 92116, 92117, 91818, 91819, 92210; Other medical practitioner items—92118, 92119, 92120, 92122, 92123,
91820, 91821; Occupational therapist items—91172, 91173; Social workers items—91175, 91176; Clinical psychologists
items–91166, 91167; Psychologists items—91169, 91170.

The Productivity Commission has recognised the benefits of expanded telehealth consultations
in improving consumer access to services.120 It has recommended that the Commonwealth
Government makes telehealth access to mental health services permanent.121 The Commission
considers that such a reform will help increase access to treatment, care and support for a
wide range of consumers accessing primary mental health services.

Chapter 8: Finding and accessing treatment, care and support, Chapter 6: The pillars of the
new service system—community‑based mental health and wellbeing services and Chapter
9: Crisis and emergency responses recommend that digital services and modes are made
available to consumers to improve accessibility and flexibility. Chapter 13: Supporting the
mental health and wellbeing of young people also suggests that digital services be made
available to young people seeking treatment, care and support.

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Using digital mental health interventions to expand treatment, care and

support options

There is also a growing body of evidence indicating that digital mental health services
other than telehealth have the potential to increase access to mental health services and
reduce demand on downstream services. Supported digital services and self‑help supports
have been recognised as an effective means of expanding access to quality treatment,
care and support for some consumers, especially those with mild or moderate depression
and anxiety.122

A number of organisations have called for the proper integration of digital supports into
service delivery, to be offered as part of a range of treatment options.123

There are several evidence‑based, supported digital services available that research
indicates are as effective as face‑to‑face therapy of the same nature.124 Some examples
include THIS WAY UP and Mind Spot.125

The Productivity Commission conducted a detailed review of the potential for supported
digital services to improve access to care.126 It found that by improving access to these
types of services, more consumers can access support that improves their wellbeing.127 It
has recommended that the Commonwealth Government funds the expansion of supported
digital interventions as routine treatment, as part of its new digital platform.128

There is also a broad range of digital self‑help supports and online peer forums that can help
people manage their own mental health needs and wellbeing. Like supported digital services,
self‑help supports offer the potential to expand access to treatment, care and support. The
Productivity Commission recognised the benefits such supports can play in improving access
and choice recommending that steps be taken to improve people’s ability to select and
connect with relevant supports as appropriate.129

Mr John Brogden, Chairman of Lifeline Australia, suggested that one of the most promising
opportunities for digital technology is the delivery of outbound services to keep in touch with
people in between sessions.130 He said that where the consumer consents, automatic text
alerts could provide check‑ins or reminders that may make a difference to someone.131

For example, the South East Primary Health Network has been trialling ‘Nellie’—an
automated text service that prompts consumers with high levels of anxiety or depression to
remember to use their coping strategies, or to complete daily activities.132 Clinicians are able
to review Nellie’s data to see whether people are responding, identify any red flags early, and
contact the consumer if needed to offer treatment.133 While still a trial, some consumers are
responding very well to the text messages, because it feels like personal contact.134

Blended models of care are also being introduced. As explained in Box 34.1, blended models
of care integrate online therapy and wellbeing support with face‑to‑face service delivery.
This can provide people with immediate access to support while they wait for a face‑to‑face
session, continuing care in between face‑to‑face consultations, and aftercare and recovery
support to prevent relapses.135

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Royal Commission into Victoria’s Mental Health System

Personal story:

Anh Nguyen
Anh accessed mental health support through Orygen when she was going through
a ‘rough time’ at university. Towards the end of her treatment, her case manager
suggested she try using Moderated Online Social Therapy (MOST)—an online platform
that provides a safe online social network, personal therapy programs and resources to
support mental health.

Anh said she found the online environment comforting and supportive, because it made
her feel like she was not alone, no matter what the time of day.

When I started going on to it, I felt more comfortable and relaxed, knowing that
I’ve got others around to support me. If I had any problems, I could contact
someone and they would be able to help make me feel a lot better and I know that
I’m never alone.

It’s a comfortable feeling knowing someone is there. They’re on there 24/7, if you
need someone at a bad time, they’re just there and they’ll appear and start talking
to you, making you feel a lot better.

Anh said she found the platform had a strong community feel, which positively
contributed to her own mental health.

You can post whatever you’ve got to say, for example, something encouraging, and
then you can just say, ‘this is what brightened up my day and I hope it brightens
up your day as well’. I remember seeing people commenting on my post that it had
actually brightened up their day and that made me feel a lot better as well.

Despite sometimes talking to clinicians who Anh may not have worked with before, she
still felt it was easy to connect with them.

They made themselves approachable like a friend, a very close, trusted friend so
that I was able to express myself.

Anh said the accessibility of the program can fill a gap between face‑to‑face
appointments.

When I started having an episode, I wasn’t always able to get an appointment with
my case manager as soon as possible. Then when I did see my case manager, the
episode was gone and I couldn’t really explain how bad it was. I felt really down
because I couldn’t talk to anyone about it during that time phase. But MOST is
carried in your pocket, you can message your case manager straight away and
explain to them what’s going on.

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Anh said the platform helped her make social connections as well.

One of the workers would say, ‘we’re going to have a little social gathering’, and
then anyone that’s able to come can start meeting with each other and talking.

Anh spoke of a cartoon on the platform that she found supportive.

It was a step by step cartoon that illustrated someone going through the same
experiences as I was, with the help of the cartoon, it guided me through how to
take control of my own wellbeing, as well as how to manage how I was feeling and
that it was alright to stop and take a deep breath in and just breathe to relax and
calm myself down.

Following Anh’s positive experience with the platform, she would like to see it expanded
to more young people. Anh also thinks it could be a good access point to connect to
Orygen, because, she says it can be difficult to take the step of going there in person
and speaking to someone.

Sources: RCVMHS, Interview with Anh Nguyen, October 2020; Orygen, Moderated Online Social Therapy, <www.
orygen.org.au/Clinical-Care/Clinical-services/Moderated-Online-Social-Therapy>, [accessed November 2020].

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Orygen’s Moderated Online Social Therapy (MOST) model is an example of blended

care.136 It offers flexible digital support to accompany face‑to‑face services, from the
time a consumer enters the service, through to after they have been discharged from it.137
Consumers can chat with clinicians in real time, 24 hours a day, seven days a week.138 They
can also use evidence‑based interventions at home, a safe and supportive social network
site, and talk to peer support workers.139

Early modelling suggests that 30 per cent of young people may not need face‑to‑face
support once they access the digital service, which could free up waiting lists​.140 It also
indicates that approximately 25 per cent of young people could require at least one fewer
session of face‑to‑face treatment,141 and approximately 33 per cent of young people could
experience fewer relapses, or relapses of lesser intensity.142 This could mean better health and
wellbeing outcomes for young people and better allocation of resources and workforce to
helping those with more complex needs.

34.3.3  Expanded and personalised

service options and channels
Having access to services and information through a range of channels, including telehealth,
text, email, web and phone, offers people more choice, flexibility and control in the ways
they receive treatment, care and support.143 There are significant opportunities to use this
personalisation and flexibility to provide more specialised and targeted responses to some
consumers and cohorts who struggle to use services.

For example, many digital options allow people to access support at a time and in a way
that is convenient to them.144 Ms Julie Anderson, Senior Consumer Advisor in the Office of
the Chief Mental Health Nurse and the Office of the Chief Psychiatrist in Victoria, told the
Commission in a personal capacity that digital options allowed her to receive support without
compromising her work schedule and in a way that protected her privacy:

I think digital approaches are helpful for young people and people generally who are
working in this digital age. For me personally, because I work, it is easy for me to get
online or to look up something up. I don’t have a lot of time to attend appointments and
things like that, so online is really great and allows me to easily access information on
mental health and mental health services in a timely way. It is also private and people
around me don’t need to know what I’m doing.145

Dr Haskelberg told the Commission that online courses like THIS WAY UP improve
convenience and allow people who wouldn’t otherwise have access to treatment, care and
support to access it when they want to, and faster.146

As suggested by headspace, some digital interventions, such as text‑based support or

self‑help tools, can be appealing to people who may otherwise not seek mental health
support.147 One submission noted that text messaging can be much less frightening for some
people, which can help them to reach out:

The suicide hotlines work reasonably well but not for people who are too scared to pick
up the phone. More app based suicide prevention services might be more useful. This
way the person can text their message which is much less frightening.148

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Dr Gooding suggested that being able to seek support anonymously may be very important
to people who are concerned about sharing personal information locally.149 This could include
people in small or marginalised communities, people who may fear stigma, people who
identify as LGBTIQ+, and Aboriginal people.150

One person at a community consultation noted that traditional phone‑based supports don’t
always work for young people, especially boys. They suggested the system should be making
far better use of online channels and forums to offer support to these groups:

Helplines by phone don’t work for youth, boys in particular. They won’t pick up the phone
to ask for help. Instead, they share online. There is an opportunity to make far more use
of the potential … support networks [youth are] seeking on the internet, instead of (or in
addition to) phone availability.151

Technology can also offer more personalised and inclusive services and support, particularly
for diverse communities and groups. Alex Smith, a witness before the Commission, said that
access to online social media support had helped them to connect with other gender diverse
people, and the resource helped them through a challenging time:

A transgender and gender diverse organisation in Victoria runs a really, like, wonderful
online Facebook group … which is for trans masculine people … That was an amazingly
important resource for me … I really couldn’t have continued with work, I think, without
having that online Facebook group.152

Foundation House noted that innovative responses to translation services can support
culturally diverse communities to access services and supports that are tailored to their
language and cultural needs.153 They cited examples of some specialist service providers
recording phone or video messages in consumers’ preferred languages to organise
appointments, rather than written text.154

Mental Health Australia, the Federation of Ethnic Communities Councils of Australia and the
National Eating Disorders Association jointly told the Productivity Commission that online
services have the potential to break down language barriers and deliver services that are
understanding of and responsive to people’s individual cultural backgrounds and beliefs:

For culturally diverse communities, online services could support individuals in their first
language and/or understand their cultural norms and values around mental health and
wellbeing. This includes established migrant and refugee communities here in Australia,
international students, and second‑generation Australians who may not need someone
who speaks a language other than English but do need someone who understands the
nuances of their cultural background.155

Chapter 21: Responding to the mental health and wellbeing needs of a diverse population
recommends developing user‑centric digital technologies to support delivery of accessible,
confidential, timely language service delivery for mental health and wellbeing.

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34.3.4  Improved productivity and efficiency

In addition to consumer benefits, technology can have a range of service and system
benefits. For example, the proper use of electronic records, e‑referrals, telehealth and other
technology can be a means to reduce administrative workloads and manual tasks for service
providers.156 A reduced administrative burden can leave workers more time to deliver their full
scope of practice, to the benefit of consumers.157

In their 2019 review of digital technology and mental health, Reinhard Michael Krausz and
colleagues suggested that the use of digital technology in mental health services can
contribute to ‘a more accessible and cost‑effective system of delivery’.158 They cited reduced
travel costs, less administrative work, and wider reach and scale as the leading benefits of
digital technologies.159 In its 2018 report on the Future of Health, the Commonwealth Scientific
and Industrial Research Organisation (CSIRO) also found that telehealth and digital services
can drive efficiency and cost‑effectiveness through a reduction in hospitalisations, reduced
consumer transport costs and shorter waiting lists.160

Service providers and clinicians have indicated that they want technologies that reduce the
amount of administrative work they have to do, that provide access to information that helps
them do their jobs well and more efficiently, and that supports consumer continuity of care.161
The Commission was told about a number of ways in which digital technology is supporting
these goals.

For example, both Mr Shane Solomon, Partner at Caligo Health, providing evidence in a
personal capacity, and Professor Rob Moodie, Deputy Head of School and Professor of
Public Health at the University of Melbourne, individually noted that online and telehealth
technologies can be more efficient for mental health workers.162 They both suggested their
use may cut workers’ travel time, allowing them to have longer sessions with consumers and
potentially see more consumers.163 Dr Deveny also noted that digital technologies provide the
flexibility for workers to be located anywhere when delivering services.164

The Commission’s interim report indicated that telehealth and other technologies are being
used for triaging and urgent assessment, which can reduce the need for some consumers
to be transported by ambulance to larger hospitals in rural and regional areas.165 Associate
Professor Ruth Vine, Director of Forensicare, suggested the advantage of screening and
triage services being provided digitally is that the services can be accessed from anywhere,
and by consumers, service providers and emergency services.166 This not only reduces the
burden on consumers having to travel but also reduces the amount of resources that have to
be dispatched. However, Associate Professor Vine said that mental health services depend on
interpersonal relationships and does not believe it is possible to do a thorough mental state
assessment of an acutely unwell person online.167

Further, the Commission was told that online and phone‑based service delivery may reduce
the number of ‘no‑shows’—that is, people who do not attend an appointment.168 No‑shows
reduce the amount of productive time a worker has during the day, as well as the number of
consumers they can see.169

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Professor Ian Hickie AM, Co‑Director of Health and Policy at the Brain and Mind Centre at
the University of Sydney, confirmed in a personal capacity that the introduction of telehealth
services has resulted in a reduction in non‑attendance rates for people attending GP
clinics.170 He suggested that this reduction is likely due to consumers being able to attend
consultations in their own home.171 The organisation headspace produced a report about
the experience of its workforces using telehealth during the COVID‑19 pandemic. The report
noted that the impact of the COVID‑19 pandemic on consumer attendance was mixed, with 41
per cent of the workforce indicating that slightly or considerably fewer clients had cancelled
or missed their appointment, but that 30 per cent had also found that more clients had not
attended appointments.172

There are many reasons that people may be unable to attend a face‑to‑face appointment. As
noted earlier, mobility issues, physical or mental health interruptions (including worsening of
symptoms), and caring responsibilities can all be reasons that a person may struggle to make
it to a face‑to‑face session. Telehealth can provide people with more flexibility to attend their
appointments from their own home, and in hours that may suit them more.173

34.3.5  Feedback, accountability and performance

There is a lot of emphasis on the benefits of technology to service delivery, but digital
technology can also contribute to better monitoring, data collection and feedback systems.
Professor Hickie said, ‘[t]he role of data tracking and feedback systems in both improving
service quality and system responsiveness cannot be underestimated.’174

Dr Gooding suggested that digital data systems can help monitor the activity and
performance of services, system administrators and advocates to ensure services are
being delivered effectively and safely.175 For example, one New South Wales research team
used technology to monitor medicine use in aged care facilities across Australia to identify
excessive prescription of antipsychotic medication and flag areas for further checks.176
Such an approach may be beneficial in monitoring the use of restrictive practices in
inpatient units.

New tools can also empower consumers to directly provide feedback about the system or
a service, and then monitor the response to that feedback.177 Consumers should be able to
electronically submit a complaint and easily see its progress through the system.

Better data collection systems and data analytics can also provide services, system
administrators and researchers with a wealth of information to identify where interventions
and programs are working, and where more needs to be done.178 Chapter 35: New approaches
to information management, discusses the need for better information systems and
processes, and recommended solutions, in detail. Chapter 30: Overseeing the safety and
quality of services, and Chapter 36: Research, innovation and system learning also note the
importance of better using technologies to inform data collection and system improvement.

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34.3.6  The challenges of digital mental health technologies

While there are many benefits to integrating digital technology in mental health and
wellbeing services, there are also potential limitations and risks that the system needs to
carefully consider.

Digital interventions on their own may not be appropriate for some people with high‑intensity
needs. Professor Alan Rosen AO, Professorial Fellow in the Illawarra Institute for Mental Health
at the University of Wollongong and Clinical Associate Professor of the Brain and Mind Centre
in the Sydney Medical School, University of Sydney, suggested the ‘more severe’ a person’s
mental illness is, the more likely they are to need in‑person interdisciplinary services.179 While
Professor Rosen noted that digital supports can still augment care, they are unlikely to be
effective on their own.180 Dr Haskelberg holds a similar view to Professor Rosen, suggesting
that digital tools should be part of a more comprehensive suite of interventions.181

While some people with lower intensity needs relating to their mental illness or psychological
distress may respond well to online interventions, many digital mental health and wellbeing
apps and online courses are general in nature, or may lack a strong evidence base.182 The
University of Melbourne told the Productivity Commission that a number of digital products
appear to have been developed without consumer or clinical expertise, reducing their
usability and effectiveness.183

A 2019 study found that most apps are sold as therapeutic tools but have not been evaluated
rigorously.184 They may be informed by evidence‑based treatments, but this does not mean
they actually deliver evidence‑based services to consumers.185

While some people may stop using digital supports once it has met their needs, a lack of
rigorous development can be a reason people drop out of these services. A review of clinical
trials of smartphone apps to support people with depression indicated that drop‑out rates
were approximately 50 per cent.186 Only 4 per cent of mental health users continue using
mental health and wellbeing apps after two weeks, and even this statistic is not necessarily
meaningful because people only need to open the app—not use its features—for this to
be measured as ‘continued use’.187 It suggests people may not receive the results that were
expected, or may have higher hopes than the app or course can deliver.

Online and mobile interventions need to provide transparency of intended benefits and
limitations to help consumers manage expectations and decide if the option is truly right
for them.

Dr Haskelberg noted that people may be overwhelmed by the multiple digital interventions
available188 and may find it difficult to navigate and select the digital tool that best suits their
personal needs.189 Orygen also raised concerns that some digital services may have limited
quality control, safety measures and evidence to inform their development, making them
unsuitable as standalone supports for people.190

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Consumers may be concerned about the safety and privacy of their data and personal
information when using such technologies. Dr Gooding and Professor Hickie both noted
that there can be a lack of transparency in mental health apps and websites about privacy
policies, data sharing practices and commercial interests.191

Victorians have a right to privacy under the Charter of Human Rights and Responsibilities Act
2006 (Vic), and they should have reassurance that the services and supports they are using
will maintain their privacy and trust.

The Productivity Commission has recommended that the Commonwealth Government

improves advice and support to the public and service providers on how to select
evidence‑based and safe digital services that are appropriate for consumers’ needs.192
The Australian Commission on Safety and Quality in Health Care has also released the
new National Safety and Quality Digital Mental Health Standards to improve the quality of
digital mental health service provision and protect consumer safety. The standards describe
the level of care and the safeguards that digital mental health services should provide
consumers and providers.193

The Commission was also told that if not implemented correctly, new technologies could
potentially increase pressure on services as they strive to input data into multiple systems,
which may reduce efficiency.194 For example, Professor Emeritus Bruce Singh AM, Clinical
Director of Mental Health Services at South West Healthcare, Warrnambool told the
Commission in a personal capacity that the introduction of some electronic medical records
has resulted in increased administration work, rather than more time for face‑to‑face service
delivery.195 New technologies should create efficiencies for services and relieve administrative
burden for professionals, rather than compound these issues.

34.3.7  Weighing the benefits and challenges

As noted earlier, technology use in the mental health and wellbeing system will continue to
grow rapidly in response to people’s preferences and needs. On balance, the Commission
considers that technology’s many benefits and the evidence quickly evolving from the
response to the COVID‑19 pandemic are promising and therefore should be built on. The
Commission encourages the Victorian Government to work to integrate digital technologies
into mental health and wellbeing services in a way that is safe, inclusive of diverse needs,
appropriate, cost‑efficient and that ultimately adds value for consumers, services and
professionals.

There is a risk that if government and the mental health and wellbeing system do not move to
integrate new technologies, consumers, families, carers and supporters will increasingly rely
more on private or market‑based digital mental health services, and the government‑funded
mental health services will be left behind.196 Increasing the system’s adoption of digital
technologies and the ability to use them is a necessity in a contemporary system to ensure it
can provide people with safe, effective and modern treatment, care and support.

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34.4  The task of digital integration

While a wide range of technologies already exist that can help improve the mental health
and wellbeing system, the Commission understands this is not currently being used to its full
potential.197 The Fifth National Mental Health Plan acknowledged that digital integration is
an area where mental health systems need to improve, and has committed to developing a
National Digital Mental Health Framework to guide the creation of new digital service delivery
interventions in a coordinated and safe way.198

The COVID‑19 pandemic has accelerated the integration of some forms of digital mental
health technologies into the system, such as telehealth, but it has also revealed where
improvement is needed. Mental health and wellbeing services need to build remote and
flexible working capacity, and technology is required to achieve this.199

The Commission was repeatedly told that the system’s biggest challenge is properly
integrating digital interventions with face‑to‑face services.200 Provider capacity, inequity
of access, a lack of awareness and trust, and inconsistent approaches to the adoption and
integration of technologies into service delivery, are all barriers to realising the potential of
technology, as illustrated by Figure 34.8.

Figure 34.8:  Challenges to digital integration in the mental health and wellbeing system

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34.4.1  Limited service provider capacity

The capacity of service providers to deliver digital services is a major barrier to
implementation. There is a lot of variation in how well developed digital technologies are
across the mental health system, and this creates a situation where different service
providers are offering their consumers very different experiences.

Some public mental health services do not appear to offer the range of basic technological
features already demonstrated to be effective for consumers and workers, such as online
bookings, e‑referral, electronic access to personal health information and service delivery
through multiple channels such as telehealth and text.

Under the former Department of Health and Human Services’ digital health strategy, health
services are building their capacity to deliver digital services.201 However, Ms Peake suggested
there is disparity between the adoption of technology in general health and mental health. 202
She said the lack of parity between the two sectors has meant that digital technologies have
been integrated in a more structured way in general health than in mental health.203

There are no clear guidelines that tell mental health and wellbeing services what their
minimum digital service offerings should look like, and no strategy to guide implementation.
This has likely contributed to the varying degrees to which providers have embedded digital
technologies into their service offerings.

NorthWestern Area Mental Health Service noted that this lack of strategic, service‑level
planning affects the system’s ability to deliver modern treatment, care and support. It also
pointed to a lack of technology funding as a problem:

The lack of a dedicated funding stream and strategic planning for digitising mental
health services has led to aging information technology infrastructure and inefficient
systems, which does not efficiently support the contemporary approach to service
delivery for instance mobile care teams. This is a significant risk in terms of transfer of
information across services and service settings.204

A number of service providers informed the Commission that as a result of this, they have
varied and often old devices and technology, which prevents them from delivering more
contemporary digital treatment, care and support.205

It also appears that many providers have not made updates to their digital systems and IT
infrastructure a priority, leading to an inability to effectively deliver digital service options
for consumers. The costs of new systems can be high due to the requirements for new
technology, workflow changes and workforce training.206

While the government has provided some funding over the past few years to introduce new
electronic records systems in some hospitals, there appears to have been little funding
support for devices, systems and interventions. More recently, the former Department of
Health and Human Services has provided IT grants to state‑funded community mental health
providers to support them to offer services remotely.207

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Royal Commission into Victoria’s Mental Health System

The Victorian Government has also recently committed $13 million to boost virtual care
technology as part of its Hospital in the Home program. 208 The funding includes investment
in new software to facilitate telehealth appointments, a trial of telehealth with Ambulance
Victoria, and the purchase of devices to make home‑based care safer for patients and
clinicians.209 These investments are good steps that can be built on.

The Commission understands that pricing and funding may not always encourage the use
of digital mental health interventions in some services. Until recently, telehealth has only
been funded through the Medicare Benefits Schedule for specific regional and rural areas
in primary and secondary health services, and its availability in metropolitan areas has
been limited.

As noted above, recent changes to the Medicare Benefits Schedule in response to the
COVID‑19 pandemic have expanded access to telehealth nationally. The former Department
of Health and Human Services also purchased additional call volumes for area mental health
services to support the switch to telehealth.210

34.4.2  Varied workforce capability and acceptance

Integration and uptake of new technologies in mental health depend on workers having the
skills and mindset to confidently and adeptly use a range of digital technologies to benefit
consumers.211

The Commission was told that the mental health workforce is likely to require a range of
new skills to effectively use digital technologies, including communication, data security and
safety, and the ability to select and recommend the right digital tools for consumers, as well
as general technological competencies.212 Professor Alvarez‑Jimenez said that collaboration,
education and training, implementation and funding support are all needed to help the
workforce build its skills and confidence in using technology.213

The Commission understands that, traditionally, there has been some resistance among
some of the mental health workforce to the use of new technologies in mental health
services.214 However, a lot has changed over the past decade, particularly recently as a result
of the COVID‑19 pandemic. The pandemic has quickly required the workforce to embrace the
use of digital technology and has rapidly built the evidence base for certain modes of care,
such as telehealth.215

There is growing recognition among mental health service providers that digital technologies
can be used to complement current roles and practices by providing new ways to treat and
support people, monitor their progress and receive information.

Chapter 33: A sustainable workforce for the future, considers how to build and support
workforce capability in the future mental health system, including to support the adoption
of digital technologies.

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34.4.3  Inequity of access

While internet use is high among Australians and Victorians,216 there is still a noticeable ‘digital
divide between richer and poorer Australians’,217 which is likely to have a stronger impact on
people living with mental illness who wish to use digital options than on other people.218

People in rural and regional areas are less likely to have access to the internet, and the
Commission has heard that people living in these areas can often struggle to access
high‑quality bandwidth or stable internet connections, which limits their ability to access
digital mental health services.219 Aboriginal Australians, people who are unemployed, people
with low incomes and people with a disability are also less likely to have access to the
internet, and may be disadvantaged as a result.220

Even when people do have access to data or devices, these may be shared among one
household, or may be old and ineffective. The cost of mobile data or devices has been a
barrier for some people wanting to access digital support, and unreliable internet access in
some regional areas limits the effectiveness of this support.221

Ms Peake shared these concerns:

Funded mental health services are reporting that some consumers are not able to
access telehealth because cost barriers prevent them from purchasing a smart device,
while for some consumers and service providers, poor connectivity can be a barrier.222

Mr Solomon told the Commission that some investment is needed to improve consumer
access to digital resources.223 Both the Victorian Government and the Commonwealth
Government have recently invested in digital upgrades to better support rural and regional
communities to access fast internet. The Victorian Government has committed $626 million
to deliver its Digital Future Now package, which will vastly improve mobile coverage and
broadband access in regional areas.224 The Commonwealth Government has also committed
more than $4.5 billion to extend the National Broadband Network and accelerate the 5G
network.225 These investments will help rural and regional consumers to access digital mental
health services.

34.4.4  A lack of usability

Digital literacy and usability are critically important to ensure consumers, families, carers and
supporters can find, engage with and use digital technologies that could help improve their
mental health. Not all supports are user friendly, and some people may struggle to use them
successfully.226

De Beurs and others indicate in their research that it is important to take users’ needs and
preferences into account when designing and delivering mental health interventions using
technology.227 Mr Bruce Bonyhady AM, Executive Chair of the Melbourne Disability Institute
at the University of Melbourne, noted in a personal capacity that all people should be able to
enjoy the benefits of new technological advancements, but that this may be compromised
where the design of new technology discriminates against certain groups.228

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A number of organisations, including the Australian Human Rights Commission, have

promoted the need for a ‘human rights by design’ approach to developing and delivering
government services that use digital technologies, to ensure they are accessible and usable
by people living with mental illness, people living with disability and other diverse groups.229

However, because people with lived experience are often not part of the process to develop
digital mental health interventions, many barriers are overlooked.230 As a result, people with
mental illness can have difficulty using the tools that are being developed for their benefit.231

The Commission considers that digital mental health technologies and interventions should
always be inclusive and accessible and, wherever possible and appropriate, should be
designed in partnership with consumers, families, carers and supporters.

Digital mental health services may also be difficult to access for people who do not have
the technical skills to participate fully in the digital world. People need support to learn and
build the skills and confidence required to use technology.232 In saying this, services should
try, wherever possible, to use digital platforms that people are familiar with and prefer, rather
than assuming people have low digital literacy.

The Commission was told that many newly arrived migrants already engage with digital
technology but use different platforms from those typically offered in Australia.233 Adapting
services to meet the preferences and needs of consumers can be beneficial in expanding
access and usability.

A service provider at a roundtable discussing digital mental health opportunities told the
Commission that many of its consumers are already able to use technology, so it has adapted
its offerings to provide services on platforms that consumers are familiar with:

people are already digitally engaging. You know, when they come from different
countries, they’re already talking to their friends. They’re in refugee camps in different
countries, they’re already doing it. But their platforms were very different. And we have
discovered there [are] you know, 20 different platforms people are using. So the simple
thing we did was [ask] what do you use WhatsApp, FaceTime, zoom, WeChat? What are
you using currently, and tapping into those systems because they’re already familiar
and they are using it.234

34.4.5  A lack of visibility and trust for consumers and workers

The uptake of digital mental health services by consumers, families, carers, supporters and
service providers depends on their awareness of the service offerings available to them. As
previously noted, people often struggle to determine what supports are right for them and to
navigate through the range of options available. The e‑Mental Health Alliance suggested that
increasing consumer, family, carer and supporter awareness of digital mental health services
would likely result in a significant rise in their use.235 However, many consumers and service
providers are not aware of what is available or how it might be used to augment existing
treatment, care and support options.236

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Some platforms already exist to help people find supports. The Commonwealth Government’s
Head to Health website, which was co‑designed with consumers, carers, service providers,
health professionals and other interested parties, provides free access to evidence‑based
information and advice on digital mental health supports.237 There are also some supports
provided to sections of the workforce to support the uptake of digital technologies. Since
2013, E‑Mental Health in Practice (eMHPrac) has been funded by the Commonwealth
Department of Health to ‘promote the use of digital mental health services and resources by
primary healthcare providers across Australia’.238

While these resources are beneficial, those involved have suggested they can be improved.
The Productivity Commission was told that the Commonwealth’s Head to Health platform is
too generalist to provide support to some cohorts and that it has become a static website,
rather than a proper navigation tool.239

GPs and other professionals need to be better educated about available digital mental health
services and encouraged to inform and refer people to these services.240 The Productivity
Commission has recommended that Head to Health be expanded to include a broader
range of services and improved to better direct people to the right service for them.241 The
Productivity Commission has also recommended that, over time, the site be amalgamated
with the new national digital mental health platform and its gateway service offerings.242 The
Commission supports this approach.

People also need to trust digital service offerings. This requires assurance that digital
offerings will suit their needs, be effective, and that they will work well with any other
services they are using.243 It also means that people need to know the offerings are safe,
evidence‑based and meet the same quality standards as any other service offering. This
includes approval from government and services, but also from other consumers.244

Dr Deveny noted that some clinicians may choose not to refer their consumer to a digital
resource because they are unsure if it is safe:

I also am aware that some clinicians are not comfortable referring people to certain
digital health solutions because they do not know if the content of the app is evidence
based and there is concern about any potential adverse health outcome from its use.245

There is no single organisation responsible for the oversight and regulation of digital
mental health services. Oversight occurs through ‘a mix of government regulation, industry
self‑regulation, and direct education of consumers and practitioners’.246 Experts have noted
that current legal and regulatory structures for digital mental health services may not be
adequate, but there is debate about the extent to which these services should be governed.247

As a first step, the new National Safety and Quality Digital Mental Health Standards will
help to provide transparency about what good practice looks like, and ensure that digital
interventions are designed safely and effectively. While this is a good start, Dr Gooding
informed the Commission that further work will be needed to ensure these standards are
met, and consumer trust is maintained and respected.248

Ms Peake also said the standards need to be ‘complemented by local mechanisms to ensure
appropriate quality assurance frameworks are in place to facilitate the shift towards digital
health solutions’.249

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Protecting privacy and data is another challenge in the digital age. Consumers need to have
assurance that their data is being collected and used in a responsible, secure way, and only
for the purpose for which they supplied it.250 However, personal data gathered by digital
mental health technologies may have insufficient protections.251 There are digital supports
that present risks to consumer safety and privacy due to inappropriate data security
standards or on‑selling of data to third parties.252

The University of Melbourne noted that without good protections for data and information,
there is a risk that consumers’ low levels of trust will have negative flow‑on effects for mental
health service use. 253 In turn, this may be a barrier to people accessing support through these
channels.254 According to the Consumer Policy Resource Centre, ‘consumers may well start
to avoid accessing important healthcare services and support, if they feel companies or
governments cannot be trusted with that information or that they may be disadvantaged by
that information in future’.255

34.4.6  Inconsistent adoption and integration

There is currently no overall approach to support the adoption and integration of digital
services across the system so they become routine practice. There are also limited strategies
to test promising approaches and see whether they can be scaled—that is, whether they are
effective for a range of groups or only in limited circumstances. Traditional ‘develop, build
and release’ approaches to implementing new service designs are not effective because
they cannot keep up with the continuous and rapid improvement of digital mental health
technologies.256 One mental health technology entrepreneur at an innovation roundtable
noted that the mental health system needs to take a more iterative approach to adopting
new technology:

the current system is built for products that release once and in a similar way that
you might have a drug and don’t change for the next three years. That’s not how you
build a technical product. And that won’t be how you build the best technical products
for years to come. In terms of both usability from a patient’s perspective, usability
from a healthcare perspective, effectiveness on outcomes, everything is tied against
continuous improvement. And that’s how good products are made ... It’s all built around
this one soft build and release model, which won’t survive long term. [We should be]
focused around how we can create more of an iterative process to policymaking
that adapts to changing products and changing environments in the product
developer process.257

Another entrepreneur noted that current research and implementation approaches are too
slow and are hampering progress:

I think fundamentally, the challenges for health services, that we have an accepted
gold standard of evidence that’s required before something is taken up and integrated
into clinical practice. And until we’re willing to flip that, and actually experiment with
and adopt these new technologies, we’re going to keep getting the same solutions …
Research is done in a university context, it may or may not get adopted, if it does, it
probably takes 10 to 15 years, by which point, the technology is well and truly out of date.
And so, I think as a system, we need to be creating an environment where it is accepted
that we can take these new technologies, use them in our practice, and then grow
from there.258

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Professor Alvarez‑Jimenez told the Commission that the integration of digital supports
requires new approaches to the development, research and funding of digital technologies in
mental health to accelerate their adoption into routine practice over time.259

34.4.7  Carving a way forward

In light of the evidence before it, the Commission is confident that digital technologies should
be integrated into the mental health and wellbeing system to provide better access, choice
and flexibility for consumers, families, carers and supporters. However, structural change and
new arrangements will be necessary to ensure they can be effectively, safely and efficiently
integrated with service delivery.

The Commission sees a need for:

• clear guidance and pathways to support the integration of digital mental health
technologies into routine service delivery and to create greater service consistency and
equity across Victoria
• greater support for services to build their digital offerings
• better support for disadvantaged groups and consumers to access technologically
enabled mental health services to the same level as others, if that is their preference.

Regardless of what technologies are used across the system, consumers, families, carers and
supporters must have reassurance that they can trust the technology and service offerings
available.

While the Commission understands there is support for the greater adoption of digital
technologies into mental health services, most consumers, experts and service providers
have emphasised that people should still have a choice about how they wish to receive
services, including face‑to‑face services, wherever possible. The Commission agrees that this
choice should lie with the consumer, and they should receive appropriate information, advice
and support to help them decide which services best meet their needs.

Considering this, the Commission recommends that the Victorian Government ensures that
public mental health and wellbeing services have the ability to offer consumers, families,
carers and supporters a consistent suite of digital services. These offerings should meet
people’s individual needs and provide them with an improved experience across their
entire recovery journey. To achieve this, the Commission recommends that the Victorian
Government implements several initiatives.

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34.5  A statewide approach to

building service provider capacity
The Commission considers that there should be a much stronger focus on building service
provider capacity to deliver digitally integrated mental health and wellbeing service offerings.

In other jurisdictions and sectors, policymakers and funders have implemented clear
and concise digital service requirements and guidance to help service providers deliver
contemporary digital service offerings.

Victoria’s Digitising Health strategy guides overall digital health policy and investment in
Victoria’s general health system.260 It reflects a general health system that is well on its way to
improving digital service delivery and technology capacity. However, mental health remains
behind general health in integrating digital channels into service delivery, and requires a
strategy that is tailored to support the adoption of forthcoming reforms and accelerate
uptake of technology. Such an approach will also ensure accountability for implementation
and provide clear timelines and milestones.

In the province of Ontario, Canada in the Ministry of Health has developed new minimum
recommended requirements to ensure the basic digital tools and functionalities are in
place across health teams.261 These requirements are underpinned by digital health policy
guidelines to ensure a consistent approach to setting up digital supports across the
province.262 The guidelines give service providers directions on selecting, procuring and
implementing digital technologies. They include four general digital health policy directions
and three system‑specific policy directions.263

The four general digital health policy directions support the implementation and use of all
digital health systems. 264 They focus on:

• information exchange expectations—for example, minimum interoperability

standards to promote efficient and seamless access to electronic patient information
across services
• digital health investment and value for money expectations—for example, guidance to
ensure service providers achieve value for money, invest in innovations and utilise their
collective purchasing power
• digital health access and privacy and security—for example, policies to implement
good practice information collection, use and disclosure, in compliance with relevant
legislation
• digital health reporting and performance—that is, indicators that ensure investments
in IT are transparent and accountable.

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The three system‑specific policy directions guide providers' digital service delivery and
require them to offer consumers virtual consultations, and digital self‑management tools
including access to digital information, online booking functions and e‑referral.265

The Commission supports this approach. It offers consistency and transparency, and
provides a clear framework for integrating, investing in and making digital supports a priority,
without stifling innovation or flexibility.

To this end, the Commission recommends that the Department of Health develops and
implements new statewide minimum digital service requirements for all publicly funded
mental health and wellbeing service providers. The requirements should align with the
Commission’s recommended service standards and further define the general digital
capacity expected of all service providers. They should be broad enough to allow for
technological advancements that are not yet anticipated.

As a minimum, the requirements should include the statewide uptake of telehealth (video
preferred and phone if video is not possible), access to services through multiple channels,
e‑referrals and online booking capability. They should also support and inform the necessary
investment in interoperability functionality—that is, the ability for IT systems to connect to
one another, and support electronic information exchange for service delivery and service
accountability, with relevant parameters.

The requirements should be supported by a new statewide digital mental health and
wellbeing strategy and framework that articulates the Victorian Government’s approach to
improving service providers’ capacity to use digital technologies across the mental health
and wellbeing system over time, the desired outcomes to be achieved, and the statewide
roadmap to support integration. It should clearly set out the IT infrastructure needed to
ensure digital mental health technologies are adopted.266

At the service‑provider level, organisations should be supported to assess how advanced

their digital offerings are (that is, carry out a digital maturity assessment), using a consistent
and agreed framework, so they can develop their own local digital transformation road maps.

One model that could be explored is the National Health Service in the United Kingdom,
which has introduced digital maturity assessments as part of a comprehensive digital health
transformation plan.267 These have led to the development of 73 local digital road maps, which
are championed by chief information officers across service areas.268

At the local level, the maturity assessments and road maps are used to promote local service
investment and transformation, in a uniform and staged way.269 System‑wide, the information
has allowed the United Kingdom to create its first digital maturity index for health, to monitor
progress and determine investment priorities for the future.270

Requirements should be designed in consultation with consumers, families, carers and

supporters and service providers to ensure they meet the needs of people using and
delivering the services.

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The Commission suggests following these principles when developing requirements:

• High‑quality and safe services are delivered in alignment with established standards
of treatment, care and support, new digital mental health standards and the pending
national digital mental health framework.271
• Requirements are informed by the experiences and preferences of consumers, families,
carers and supporters.272
• Digital services promote and support diversity and cultural inclusiveness, including
through accessibility and language options.
• Alternative approaches are available, wherever possible, recognising that it is the
consumers’ choice whether they wish to use digital services.

34.5.1  Funding support to build service capacity

Digital expectations and requirements will provide greater clarity, but service providers will
also require appropriate funding and support to meet them. For example, Associate Professor
Stafrace said that consumers and service providers will need access to devices, data plans
and high‑speed internet to take full advantage of technologies.273

It is highly unlikely that all mental health service providers will have the digital capacity or
maturity to meet the requirements quickly. At the state level, some community mental health
services and hospitals lack the devices and high‑speed internet to support a major shift in
service delivery.274 As the provider landscape adapts to deliver the new system, new providers
will be expected to demonstrate or build their digital capacity, in order to deliver on digital
requirements.

The Commission recommends that the Department of Health provides some form of
dedicated capability funding to help organisations build their digital maturity over time,
linked to the statewide framework and service‑level maturity assessments. In the United
Kingdom, the National Health Service introduced the Integrated Digital Care Fund to support
providers to develop their maturity over time.275

Investment in regional areas should be given priority in the first instance to support Local
Mental Health and Wellbeing Services, Area Mental Health and Wellbeing Services and
statewide services to procure new technologies, introduce innovation and build their
capability to deliver digitally integrated service offerings. Chapter 24: Supporting the mental
health and wellbeing of people in rural and regional Victoria, discusses this approach in
more detail.

To improve cost‑efficiency—that is, to get value for money—the government could also
consider purchasing some technology where it would make sense to have consistency
across the state. For example, the government could purchase licences for a preferred
telehealth system, for rollout across community and inpatient mental health services. The
Commonwealth Government has already provided free access to a preferred and secure
telehealth platform for all GPs.276

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The Victorian Government should also identify digital interventions that have shown positive
outcomes for consumers, and invest in rolling them out across the state. For example, in April
2020, the Victorian Government provided funding to Orygen to implement its Moderated
Online Social Therapy (MOST) program across all state‑funded child and adolescent youth
mental health services and all Victorian headspace centres by mid‑2021.277 The significant
research and evaluation effort put into Moderated Online Social Therapy (MOST) over the
last decade has resulted in the government choosing to fund, expand and roll out the model
statewide.

This expansion will allow all young people in headspace or child and youth mental health
services to receive digital services that are fully integrated with their face‑to‑face therapy,
if they wish to. A new partnership between Orygen and other state youth services will deliver
the service. While careful evaluation of the rollout is needed, it could be a model for future
projects.278

34.5.2  Ensuring safety while sparking innovation

The Commission understands that digital mental health technologies must be effective,
based on strong evidence, and protect the rights and safety of those using them.

Existing legislation and policy set out privacy standards and protections for many digital
mental health interventions, but as technologies change, so too will the governance and
regulation needed.279

As its first step towards ensuring consumer safety, the Victorian Government should promote
all relevant standards and policies for digital mental health, including the new National
Safety and Quality Digital Mental Health Standards. As the evidence grows, the government
should ensure that governance, funding and regulatory arrangements continue to account
for any impacts of digital technologies on service delivery and consumer wellbeing.

A roundtable participant told the Commission that the government should consider which
tools it makes available, and how closely it oversees them, based on the level of risk and
benefit to consumers:

there is a need to have a wide variety of tools available [but] we actually want to make
sure that for those that are being used for the most serious of conditions, we … require
a level of evidence and rigor and quality assurance … There may however, be other tools
that we think are useful, but don’t require that level of evidence … And we don’t think
they need such a strong and rigorous evidence base. But we do want to make sure …
they’re reasonable, they don’t make outlandish claims for people. And then there may be
a whole lot of other tools that we make freely available with very little controls.280

Supported digital services or interventions that deliver mental health services should be
subject to appropriate tests and safeguards to ensure consumer safety is upheld. The new
Collaborative Centre for Mental Health and Wellbeing should play an active role in publicly
endorsing evidence‑based and quality mental health technologies.281 This will help to build
consumer, carer and service provider trust in good‑practice technologies.

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34.6  Better supports that

improve equity of access
All Victorians are entitled to access and use digital mental health services and channels,
if they prefer to do so. Increasing disadvantaged consumers’ access to digital equipment
and the internet will help them to use digital mental health technology as part of their
treatment, care and support. Improving strategies to support consumers’ digital literacy will
also help them to better engage with digital mental health technology and gain the most
benefits from it.

In April 2020, the former Department of Health and Human Services announced it would supply
phones and extra data to eligible clients of public mental health services to help them stay
engaged with treatment and services during the COVID‑19 pandemic.282 Associate Professor
Stafrace said the impact of such a program is difficult to measure. 283 He did note, however, that
the pandemic and the resulting reduction in face‑to‑face content has not slowed the provision
of community services, indicating that the program may be having some effect.284

The Victorian Government has also recently committed funding to deliver more Hospital in
the Home health care.285 Investment includes software to facilitate telehealth appointments
and purchasing of devices to make home‑based care safer for consumers and clinicians.286

The Commission recommends that the Department of Health uses these programs as a
model, and allows Local Mental Health and Wellbeing Services, Area Mental Health and
Wellbeing Services and statewide services to offer digital support packages to eligible
consumers. These packages will provide access to devices, data and digital literacy support.

The digital support packages should be offered to eligible consumers who have
demonstrated disadvantage and cannot access data or devices of their own. The package
should be directly connected to the supports a consumer is receiving, and should be open
to all eligible consumers receiving mental health and wellbeing services through the state
government, including adults, young people and children. The package would be strictly opt
in, and based on a consumer’s preference to use digital tools to access mental health and
wellbeing services.

The support packages should be funded through the Victorian Government, but the government
could also work with technology companies that are willing to provide in‑kind contributions
to the program, such as devices and data. The government could also consider setting up a
donation program that allows members of the public to provide their second‑hand devices (in
good working condition) to mental health and wellbeing services for use by consumers.

The Department of Health should also support mental health and wellbeing services to offer
digital literacy support to any registered consumer who wishes to use digitally integrated
services, potentially through the future system’s new recovery colleges (or discovery colleges),
as outlined in Chapter 7: Integrated treatment, care and support in the community for
adults and older adults and Chapter 13: Supporting the mental health and wellbeing of
young people.

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This support should include teaching consumers about:

• the basics of using the chosen technology and intervention—for example, how to work
a smartphone, and how to connect to telehealth services or a chosen mobile app
• safe and effective use of their chosen technology and intervention
• risks and benefits of digital intervention
• how to use the technology safely—for example, having telehealth consultations in a
space where their conversation cannot be overheard
• data and privacy protections.

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1 Royal Commission into Victoria’s Mental Health System, Interim Report, 2019, p. 527.
2 Department of Health and Human Services, Digitising Health: How Information and Communications Technology
Will Enable Person-Centred Health and Wellbeing Within Victoria, 2016, p. iv.
3 Australian Digital Health Agency, Safe, Seamless and Secure: Evolving Health and Care to Meet the Needs of
Modern Australia: Australia’s National Digital Health Strategy, 2017, p. 3.
4 Piers Gooding, Mapping the Rise of Digital Mental Health Technologies: Emerging Issues for Law and Society,
International Journal of Law and Psychiatry, 67 (2019), 1–11 (pp. 1–2).
5 Department of Health and Human Services, p. 2; CSIRO, Future of Health: Shifting Australia’s Focus from Illness
Treatment to Health and Wellbeing Management, 2018, p. vii.
6 Jennifer Nicholas and others, Issues for EHealth in Psychiatry: Results of an Expert Survey, Journal of Medical
Internet Research, 19.2 (2017), 1–11 (p. 2).
7 John Torous, Keris Jän Myrick and others, Digital Mental Health and COVID-19: Using Technology Today to
Accelerate the Curve on Access and Quality Tomorrow, JMIR Mental Health, 7.3 (2020), 1–6 (p. 1).
8 Witness Statement of Kym Peake, 4 October 2020, para. 284.
9 Witness Statement of Dr Hila Haskelberg, 13 July 2020, para. 38.
10 RCVMHS, Consumer Human-Centred Design Focus Group—Crisis Response: Record of Proceedings, 2020.
11 Witness Statement of Associate Professor Simon Stafrace, 14 August 2020, para. 184.
12 Shalini Lal, E-Mental Health: Promising Advancements in Policy, Research, and Practice, Healthcare Management
Forum, 32.2 (2019), 56–62 (p. 57); Mental Health Commission of Canada, E-Mental Health in Canada: Transforming
the Mental Health System Using Technology, 2014, p. 7.
13 Lal, p. 57; Mental Health Commission of Canada, E-Mental Health in Canada: Transforming the Mental Health
System Using Technology, p. 7.
14 Ana Hategan, Caroline Giroux and James A. Bourgeois, Digital Technology Adoption in Psychiatric Care: An
Overview of the Contemporary Shift from Technology to Opportunity, Journal of Technology in Behavioral Science,
4 (2019), 171–177 (p. 171).
15 Mental Health Commission of Canada, Toolkit for E-Mental Health Implementation, 2018, p. 12.
16 Productivity Commission, Mental Health Inquiry Report, Volume 2, 2020, pp. 491–492.
17 Productivity Commission, Draft Report on Mental Health, Volume 1, 2019, p. 208.
18 Witness Statement of Dr Hila Haskelberg, para. 8.
19 Beyond Blue, Submission to the RCVMHS: SUB.0002.0029.0099, 2019, p. 18; Gooding, p. 4; Commonwealth
Department of Health, Head to Health, <www.headtohealth.gov.au/>, [accessed 9 November 2020].
20 Smiling Mind, Briefing Note to the RCVMHS: CSP.0001.0118.0001, 2020, p. 1; Calm Blog, About, <www.calm.com/blog/
about>, [accessed 14 December 2020].
21 iMoodJournal, About, <www.imoodjournal.com/>, [accessed 14 December 2020].
22 Simon Hoermann and others, Application of Synchronous Text-Based Dialogue Systems in Mental Health
Interventions: Systematic Review, Journal of Medical Internet Research, 19.8 (2017), 1-10 (p. 1).
23 World Economic Forum, Empowering 8 Billion Minds Enabling Better Mental Health for All via the Ethical Adoption
of Technologies: White Paper, 2019, p. 14.
24 Crisis Text Line, Text HOME To 741741 to Connect with a Crisis Counselor, <www.crisistextline.org/>, [accessed 17
November 2020].
25 Doris Erbe and others, Blending Face-to-Face and Internet-Based Interventions for the Treatment of Mental
Disorders in Adults: Systematic Review, Journal of Medical Internet Research, 19.9 (2017), 1–15 (p. 2).
26 Clare Liddy and others, The Current State of Electronic Consultation and Electronic Referral Systems in Canada:
An Environmental Scan, Studies in Health Technology and Informatics, 209 (2015), 75–83 (p. 76).
27 Ministry of Health, Ontario, Ontario Health Teams: Digital Health Playbook, 2019, p. 31; Katie O’Leary and
others, ‘Collaborative Health Reminders and Notifications: Insights from Prototypes’, AMIA Annual Symposium
Proceedings Archive, 2018, 837–846 (p. 837).
28 Peng Zhao and others, Web-Based Medical Appointment Systems: A Systematic Review, Journal of Medical
Internet Research, 19.4 (2017), 1–17 (p. 3).
29 Kobi Leins and others, Correspondence to the RCVMHS: CSP.0001.0111.0001, To Chat, or Bot to Chat, Just the
First Question: Potential Legal and Ethical Issues Arising from a Chatbot Case Study, 2020, pp. 2–3; Aditya
Nrusimha Vaidyam and others, Chatbots and Conversational Agents in Mental Health: A Review of the Psychiatric
Landscape, The Canadian Journal of Psychiatry, 64.7 (2019), 456–464 (p. 457).
30 Commonwealth Department of Health, Head to Health, <headtohealth.gov.au/>, [accessed 9 November 2020].
31 Leins and others, pp. 3–4.
32 Grant Blashki and Simon Lock, Artificial Intelligence and Mental Health, Artificial Intelligence for Better or Worse,
Future Leaders, 2019, 73–85 (pp. 75–84).

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33 Blashki and Lock, pp. 75–84.

34 Błażej Cieślik and others, Virtual Reality in Psychiatric Disorders: A Systematic Review of Reviews, Complementary
Therapies in Medicine, 52 (2020), 1–15 (p. 2); D. Freeman and others, Virtual Reality in the Assessment,
Understanding, and Treatment of Mental Health Disorders, Psychological Medicine, 47.14 (2017), 2393–2400 (pp.
2394–2395).
35 Mary C. Masland, Christine Lou and Lonnie Snowden, Use of Communication Technologies to Cost-Effectively
Increase the Availability of Interpretation Services in Healthcare Settings, Telemedicine and E-Health, 16.6 (2010),
739–745 (pp. 740–741).
36 Mental Health Commission of Canada, Toolkit for E-Mental Health Implementation, p. 12.
37 Australian Digital Health Agency, Types of Digital Health Records, <www.digitalhealth.gov.au/get-started-with-
digital-health/digital-health-evidence-review/types-of-digital-health-records>, [accessed 10 November 2020].
38 Australian Digital Health Agency, My Health Record, <www.myhealthrecord.gov.au/>, [accessed 13 August 2020].
39 Witness Statement of Dr Piers Gooding, 25 June 2020, para. 18(g).
40 Witness Statement of Dr Piers Gooding, para. 18(g).
41 Witness Statement of Dr Piers Gooding, para. 18(a)–18(g).
42 Witness Statement of Professor Mario Alvarez-Jimenez, 10 June 2020, para. 31; Commonwealth Department of
Health and Ageing, E-Mental Health Strategy for Australia, 2012, p. 5; Dr Tom Foley and Dr Woollard, The Digital
Future of Mental Healthcare and Its Workforce: A Report on a Mental Health Stakeholder Engagement to Inform
the Topol Review, 2019, p. 11; Sandra Bucci, Matthias Schwannauer and Natalie Berry, The Digital Revolution and
Its Impact on Mental Health Care, Psychology and Psychotherapy: Theory, Research and Practice, 92.2 (2019),
277–297 (p. 279).
43 Witness Statement of Dr Piers Gooding, para. 25.
44 Witness Statement of Dr Piers Gooding, para. 25.
45 Witness Statement of Georgie Harman, 2 July 2020, para. 16.
46 Witness Statement of John Brogden AM, 7 July 2020, para. 26.
47 Witness Statement of Georgie Harman, 2020, para. 21.
48 Witness Statement of Georgie Harman, 2020, paras. 25–26.
49 Black Dog Institute, Submission in Response to the Draft Report from the Productivity Commission Inquiry into
Mental Health, 2020, p. 2.
50 Witness Statement of Dr Hila Haskelberg, paras. 12 and 39.
51 Witness Statement of Dr Hila Haskelberg, para. 101.
52 Witness Statement of Dr Hila Haskelberg, para. 34.
53 Smiling Mind, p. 5.
54 Smiling Mind, p. 2.
55 RCVMHS, BCA Digital Fireside Chat Roundtable: Record of Proceedings, 2020; CSIRO.
56 RCVMHS, BCA Digital Fireside Chat Roundtable: Record of Proceedings.
57 Kara Hinesley, Working Together to Prevent Suicide, <blog.twitter.com/en_au/topics/company/2018/working-
together-to-prevent-suicide.html>, [accessed 10 November 2020].
58 Kara Hinesley, Lifeline’s New Twitter DM Chatbot Helps Friends and Family #BeALifeline, 17 October 2018, <blog.
twitter.com/en_au/topics/company/2018/Lifeline-launches-Twitter-DM-chatbot-to-help-BeALifeline.html>,
[accessed 10 November 2020].
59 Witness Statement of Professor Mario Alvarez-Jimenez, para. 13. Citing Michael L Birnbaum and others, 'Role of
social media and the Internet in pathways to care for adolescents and young adults with psychotic disorders
and non-psychotic mood disorders', Early Intervention Psychiatry, 11.4 (2017) 290–295 (pp. 290-295); Bucci,
Schwannauer, and Berry, p. 277.
60 Independent Mental Health Advocacy, Self-Help Tool, <www.imha.vic.gov.au/self-help-tool>, [accessed 11
November 2020].
61 Gooding, p. 4.
62 Witness Statement of Graham Panther, 6 July 2020, para. 9.
63 Witness Statement of Graham Panther, paras. 1 and 13.
64 Witness Statement of Graham Panther, para. 32.
65 Witness Statement of Graham Panther, para. 9.
66 Witness Statement of Kym Peake, 2020, para. 273.
67 Witness Statement of Kym Peake, 2020, para. 279.
68 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 181.

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69 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 181.

70 Witness Statement of Kym Peake, 2020, para. 282.
71 Witness Statement of Kym Peake, 2020, paras. 280–281.
72 Department of Health and Human Services, Client Management Interface/Operational Data Store, 2019–20. Note:
Includes contacts where the consumer was not present.
73 Witness Statement of Angus Clelland, 2020, para. 15.
74 Witness Statement of Angus Clelland, para. 15.
75 Witness Statement of Kym Peake, 2020, para. 283.
76 Witness Statement of Kym Peake, 2020, para. 274.
77 Witness Statement of Kym Peake, 2020, para. 274.
78 Commonwealth Department of Industry, Science, Energy and Resources, Australia’s Tech Future: Delivering a
Strong, Safe and Inclusive Digital Economy, 2018, pp. 6–9.
79 Commonwealth Department of Industry, Science, Energy and Resources, pp. 6–9.
80 Statista, Active Social Media Users as Percentage of the Total Population in Australia from 2015 to 2020, <www.
statista.com/statistics/680201/australia-social-media-penetration/>, [accessed 14 December 2020].
81 Witness Statement of Kym Peake, 2020, para. 285.
82 Witness Statement of Kym Peake, 2020, para. 285.
83 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 184.
84 Witness Statement of Dave Peters, 22 July 2020, para. 64.
85 Witness Statement of Professor Mario Alvarez-Jimenez, para. 51; Witness Statement of Dr Piers Gooding,
para. 32(a).
86 Witness Statement of Dave Peters, para. 67.
87 Evidence of Al Gabb, 15 July 2019, p. 952.
88 Witness Statement of Dr Piers Gooding, para. 25.
89 Witness Statement of Professor Mario Alvarez-Jimenez, para. 34; G. Andrews and others, Computer Therapy for the
Anxiety and Depression Disorders Is Effective, Acceptable and Practical Health Care: An Updated Meta-Analysis,
Journal of Anxiety Disorders, 55 (2018), 70–78 (p. 76); Rebecca E. Reay, Jeffrey C.L. Looi and Philip Keightley,
Telehealth Mental Health Services during COVID-19: Summary of Evidence and Clinical Practice, Australasian
Psychiatry, 28.5 (2020), 514–516 (pp. 515–516).
90 Australian Digital Health Agency, Safe, Seamless and Secure: Evolving Health and Care to Meet the Needs of
Modern Australia: Australia’s National Digital Health Strategy, p. 17.
91 Witness Statement of Georgie Harman, 2020, para. 40.
92 Witness Statement of Professor Mario Alvarez-Jimenez, para. 56.
93 Black Dog Institute, Submission in Response to the Draft Report from the Productivity Commission Inquiry into
Mental Health, p. 2.
94 The Royal Australian and New Zealand College of Psychiatrists, Telehealth Survey Results, 2013, p. 13; Reay, Looi
and Keightley, p. 514.
95 Witness Statement of Dr Elizabeth Deveny, 8 June 2020, para. 111.
96 Witness Statement of Dr Piers Gooding, para. 30(d); Witness Statement of Georgie Harman, 2020, para. 24(a).
97 Witness Statement of Professor Mario Alvarez-Jimenez, para. 87.
98 Black Dog Institute, Submission in Response to the Draft Report from the Productivity Commission Inquiry into
Mental Health, p. 2.
99 ReachOut Australia, Submission to the Productivity Commission Inquiry into Mental Health: The Social and
Economic Benefits of Improving Mental Health, 2019, p. 17.
100 RCVMHS, Bendigo Community Consultation—May 2019.
101 Witness Statement of Georgie Harman, 2020, para. 22.
102 Productivity Commission, Mental Health Inquiry Report, Volume 2, p. 476.
103 Productivity Commission, Mental Health Inquiry Report, Volume 2, p. 476.
104 Witness Statement of Amelia Callaghan, 5 May 2020, para. 116.
105 The Royal Australian and New Zealand College of Psychiatrists, Telehealth in Psychiatry, 6 May 2020, <www.ranzcp.
org/practice-education/telehealth-in-psychiatry>, [accessed 4 November 2020].
106 Call to Mind, Submission to the Productivity Commission Inquiry into Mental Health, 2019, pp. 1–2.
107 Natalie Bradford, Liam Caffery and Anthony C. Smith, ‘Telehealth Services in Rural and Remote Australia: A
Systematic Review of Models of Care and Factors Influencing Success and Sustainability’, Rural and Remote
Health, 2016, 1–24 (p. 3).

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108 Bradford, Caffery and Smith, pp. 2–3; CSIRO, p. 26.

109 Danni Mills, Submission to the RCVMHS: SUB.0002.0025.0001, 2019, p. 2.
110 Witness Statement of Trevor Thomas, 2 July 2019, paras. 24–25.
111 Bradford, Caffery, and Smith, p. 1.
112 Goulburn Valley Health, Submission to the RCVMHS: SUB.0002.0029.0213, 2019, p. 9; Witness Statement of Dr Ravi
Bhat, 4 July 2019, para. 128.
113 Carrol Zhou and others, ‘The Impact of Project ECHO on Participant and Patient Outcomes: A Systematic Review’,
Academic Medicine, 91.10 (2016), 1439–1461 (p. 1439).
114 CSIRO, p. 26.
115 Clive Kempson, Submission to the RCVMHS: SUB.0002.0001.0066, 2019, p. 5.
116 Natasza Purser, Submission to the RCVMHS: SUB.0002.0001.0265, 2019, p. 7.
117 MBS Online, Commonwealth Department of Health, COVID-19 Temporary MBS Telehealth Services, <www.
mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB>, [accessed 14 December 2020].
118 C.L Snoswell and others, Telehealth and Coronavirus: Medicare Benefits Schedule (MBS) Activity in Australia,
19 May 2020, <coh.centre.uq.edu.au/telehealth-and-coronavirus-medicare-benefits-schedule-mbs-activity-
australia>, [accessed 4 November 2020].
119 C.L Snoswell and others.
120 Productivity Commission, Mental Health Inquiry Report, Volume 2, p. 551.
121 Productivity Commission, Mental Health Inquiry Report, Volume 2, p. 551.
122 ReachOut Australia, pp. 17–19.
123 Black Dog Institute, Submission to the Productivity Commission Inquiry into Mental Health, 2019, pp. 23–25;
ReachOut Australia, p. 18; MindSpot, Submission in Response to the Draft Report from the Productivity Commission
Inquiry into Mental Health, 2020, p. 3; Witness Statement of Georgie Harman, 2020, para. 66; Orygen, The National
Centre of Excellence in Youth Mental Health, Submission to the Productivity Commission Inquiry into Mental
Health, 2019, p. 34.
124 Andrews and others, p. 70.
125 Jill M Newby, ‘The Effectiveness of Internet-Delivered Cognitive Behavioural Therapy for Health Anxiety in Routine
Care’, Journal of Affective Disorders, 264 (2020), 535–542 (p. 541); Nickolai Titov and others, ‘MindSpot Clinic: An
Accessible, Efficient, and Effective Online Treatment Service for Anxiety and Depression’, Psychiatric Services, 66.10
(2015), 1043–1050 (p. 1043).
126 Productivity Commission, Mental Health Inquiry Report, Volume 2, pp. 491–507.
127 Productivity Commission, Mental Health Inquiry Report, Volume 2, pp. 491–500.
128 Productivity Commission, Mental Health Inquiry Report, Volume 2, pp. 495–503.
129 Productivity Commission, Mental Health Inquiry Report, Volume 2, p. 541.
130 Witness Statement of John Brogden AM, para. 79.
131 Witness Statement of John Brogden AM, para. 79.
132 Witness Statement of Dr Elizabeth Deveny, para. 107.
133 Witness Statement of Dr Elizabeth Deveny, para. 108.
134 Witness Statement of Dr Elizabeth Deveny, para. 108.
135 Erbe and others, p. 9.
136 Witness Statement of Professor Mario Alvarez-Jimenez, para. 68.
137 Orygen, Moderated Online Social Therapy (MOST) Flyer, 2020, pp. 1–3.
138 Orygen, Moderated Online Social Therapy (MOST) Flyer, pp. 1–3.
139 Witness Statement of Professor Mario Alvarez-Jimenez, paras. 69–70.
140 Witness Statement of Professor Mario Alvarez-Jimenez, para. 130.
141 Witness Statement of Professor Mario Alvarez-Jimenez, para. 131.
142 Witness Statement of Professor Mario Alvarez-Jimenez, para. 132.
143 ReachOut Australia, p. 17.
144 Jan Orman and others, ‘E-Mental Health for Mood and Anxiety Disorders in General Practice’, Australian Family
Physician, 43.12 (2014), 832–837 (p. 836).
145 Witness Statement of Julie Anderson, 28 May 2020, para. 95.
146 Witness Statement of Dr Hila Haskelberg, para. 47(a).
147 headspace, Submission in Response to the Draft Report from the Productivity Commission Inquiry into Mental
Health, 2020, p. 46.

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148 Talia Dow, Submission to the RCVMHS: SUB.0002.0010.0038, 2019, p. 1.

149 Witness Statement of Dr Piers Gooding, para. 30(b).
150 Witness Statement of Dr Piers Gooding, para. 30(b).
151 RCVMHS, Seymour Community Consultation—May 2019.
152 Evidence of ‘Alex Smith’ (pseudonym), 17 July 2019, p. 1218.
153 Foundation House, Submission to the RCVMHS: SUB.1000.0001.0868, 2019, p. 27.
154 Foundation House, p. 27.
155 Mental Health Australia, Federation of Ethnic Communities’ Council of Australia and National Ethnic Disability
Alliance, Submission in Response to the Draft Report from the Productivity Commission Inquiry into Mental Health,
2020, p. 12.
156 Witness Statement of Shane Solomon, 22 May 2020, paras. 54 and 79(a).
157 Australian Digital Health Agency, Safe, Seamless and Secure: Evolving Health and Care to Meet the Needs
of Modern Australia: Australia’s National Digital Health Strategy, p. 3; Witness Statement of Shane Solomon,
para. 79(a).
158 R.M. Krausz and others, Chapter 8: Accessible and Cost-Effective Mental Health Care Using E-Mental Health, in
Advances in Psychiatry (Cham: Springer International Publishing, 2019), pp. 129–141 (p. 129).
159 Krausz and others, pp. 132–135.
160 CSIRO, p. 26.
161 Australian Digital Health Agency, Safe, Seamless and Secure: Evolving Health and Care to Meet the Needs of
Modern Australia: Australia’s National Digital Health Strategy, p. 3.
162 Witness Statement of Shane Solomon, para. 79(b); Witness Statement of Professor Rob Moodie, 9 June
2020, para. 28.
163 Witness Statement of Shane Solomon, para. 79(b); Witness Statement of Professor Rob Moodie, para. 28.
164 Witness Statement of Dr Elizabeth Deveny, para. 103.
165 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 308.
166 Witness Statement of Associate Professor Ruth Vine, 29 April 2020, para. 103.
167 Witness Statement of Associate Professor Ruth Vine, 2020, para. 157.
168 Witness Statement of Shane Solomon, para. 79(b).
169 Parviz Kheirkhah and others, ‘Prevalence, Predictors and Economic Consequences of No-Shows’, BMC Health
Services Research, 16:13 (2015), 1–6 (pp. 1 and 5)
170 Witness Statement of Professor Ian Hickie AM, 11 August 2020, para. 120.
171 Witness Statement of Professor Ian Hickie AM, para. 120.
172 headspace, Staff Experience of Telehealth During COVID-19, 2020, p. 15.
173 CSIRO, p. 26.
174 Witness Statement of Professor Ian Hickie AM, para. 122.
175 Witness Statement of Dr Piers Gooding, para. 30(f).
176 Lisa G Pont and others, ‘Leveraging New Information Technology to Monitor Medicine Use in 71 Residential Aged
Care Facilities: Variation in Polypharmacy and Antipsychotic Use’, International Journal for Quality in Health Care,
30.10 (2018), 810–816 (p. 810).
177 Witness Statement of Professor Ian Hickie AM, para. 122.
178 Witness Statement of Professor Ian Hickie AM, para. 123.
179 Witness Statement of Professor Alan Rosen AO, 23 July 2020, para. 90.
180 Witness Statement of Professor Alan Rosen AO, para. 90.
181 Witness Statement of Dr Hila Haskelberg, para. 32(b).
182 Simon Leigh and Steve Flatt, ‘App-Based Psychological Interventions: Friend or Foe?’, Evidence Based Mental
Health, 18.4 (2015), 97–99 (p. 97).
183 The University of Melbourne, Submission to the Productivity Commission Inquiry into Mental Health: The Social and
Economic Benefits of Improving Mental Health, 2019, p. 3.
184 John Torous, Gerhard Andersson and others, ‘Towards a Consensus around Standards for Smartphone Apps and
Digital Mental Health’, World Psychiatry, 18.1 (2019), 97–98 (p. 97).
185 Torous, Andersson and others, p. 97.
186 John Torous, Jessica Lipschitz and others, ‘Dropout Rates in Clinical Trials of Smartphone Apps for Depressive
Symptoms: A Systematic Review and Meta-Analysis’, Journal of Affective Disorders, 263 (2020), 413–419 (p. 417).

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187 Dr Piers Gooding and Dr Yvette Maker, Submission in Response to the Draft Report from the Productivity
Commission Inquiry into Mental Health, 2020, pp. 3–4.
188 Witness Statement of Dr Hila Haskelberg, para. 32(c).
189 H. Wisniewski and J. Torous, ‘Digital Navigators to Implement Smartphone and Digital Tools in Care’, Acta
Psychiatrica Scandinavica, 141.4 (2020), 350–355 (p. 352).
190 Orygen, The National Centre of Excellence in Youth Mental Health, p. 34.
191 Gooding, p. 4; Witness Statement of Professor Ian Hickie AM, para. 126.
192 Productivity Commission, Mental Health Inquiry Report, Volume 2, pp. 483–484.
193 Australian Commission on Safety and Quality in Health Care, National Safety and Quality Digital Mental Health
Standards, <www.safetyandquality.gov.au/standards/national-safety-and-quality-digital-mental-health-
standards>, [accessed 3 December 2020].
194 Witness Statement of Dr Piers Gooding, para. 32(c).
195 Witness Statement of Professor Emeritus Bruce Singh AM, 23 July 2020, para. 36.
196 Black Dog Institute, Submission to the Productivity Commission Inquiry into Mental Health, p. 23.
197 Witness Statement of Terry Welch, 11 July 2019, para. 71.
198 Commonwealth Department of Health, The Fifth National Mental Health and Suicide Prevention Plan, 2017,
pp. 46–47.
199 Australian Government Services Australia, Medicare Statistics: Medicare Item Reports, <www.medicarestatistics.
humanservices.gov.au/statistics/mbs_item.jsp>, [accessed 14 November 2020].
200 Witness Statement of Georgie Harman, 2020, para. 66; Witness Statement of Professor Mario Alvarez-Jimenez,
para. 102.
201 Department of Health and Human Services, pp. v–vii.
202 Witness Statement of Kym Peake, 2020, paras. 275–276.
203 Witness Statement of Kym Peake, 2020, paras. 275–276.
204 NorthWestern Mental Health (A Division of Melbourne Health), Submission to the RCVMHS: SUB.0002.0030.0061,
2019, p. 29.
205 RCVMHS, Regional AMHS Provider Information Sharing Roundtable: Record of Proceedings, 2020.
206 RCVMHS, Regional AMHS Provider Information Sharing Roundtable: Record of Proceedings.
207 Witness Statement of Kym Peake, 2020, para. 291.
208 Victorian Government, Victorian Budget 2020–21: Overview, 2020, p. 23.
209 Victorian Government, Victorian Budget 2020–21: Overview, p. 23.
210 Witness Statement of Kym Peake, 2020, para. 291.
211 Health Education England NHS, The Topol Review. Preparing the Healthcare Workforce to Deliver the Digital
Future, 2019, p. 10.
212 Witness Statement of Dr Hila Haskelberg, para. 65.
213 Witness Statement of Professor Mario Alvarez-Jimenez, paras 185–186.
214 Wisniewski and Torous, p. 10.
215 McKinsey and Company, Returning to Resilience: The Impact of COVID-19 on Mental Health and Substance Use,
<www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/returning-to-resilience-the-
impact-of-covid-19-on-behavioral-health>, [accessed 23 April 2020].
216 Australian Bureau of Statistics, Household Use of Information Technology, 2016–17, <www.abs.gov.au/statistics/
industry/technology-and-innovation/household-use-information-technology/latest-release>, [accessed 4
November 2020].
217 Julian Thomas and others, Measuring Australia’s Digital Divide: The Australian Digital Inclusion Index 2019,
2019, pp. 5–6.
218 Witness Statement of Shane Solomon, para. 50.
219 Royal Flying Doctor Service Victoria, Submission to the RCVMHS: SUB.0002.0029.0072, 2019, p. 5.
220 Witness Statement of Professor Rob Moodie, p. 32.
221 Grow Australia, Submission to the RCVMHS: SUB.0002.0029.0325, 2019, p. 7.
222 Witness Statement of Kym Peake, 2020, para. 289.
223 Witness Statement of Shane Solomon, para. 50.
224 Victorian Government, Victorian Budget 2020–21: Rural and Regional Budget Information Paper, 2020, p. 11.
225 Commonwealth Government, Budget 2020–21: Economic Recovery Plan for Australia Overview, 2020, p. 20.
226 CSIRO, p. 10.

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227 Derek de Beurs and others, ‘Active Involvement of End Users When Developing Web-Based Mental Health
Interventions’, Frontiers in Psychiatry, 8:72 (2017), 1–5 (p. 4).
228 Witness Statement of Professor Bruce Bonyhady AM, 16 June 2020, p. 51.
229 Sophie Farthing and others, Human Rights and Technology Discussion Paper, 2019, pp. 170–171; Witness Statement
of Professor Bruce Bonyhady AM, p. 56.
230 Lisa Hoffman, Social Services Innovations—Equity and Inclusion in Digital Mental Health Literacy, Social Work
Today Magazine, <www.socialworktoday.com/archive/SO19p10.shtml>, [accessed 4 November 2020].
231 Hoffman, Social Services Innovations—Equity and Inclusion in Digital Mental Health Literacy, Social Work Today
Magazine, <www.socialworktoday.com/archive/SO19p10.shtml>, [accessed 4 November 2020].
232 CSIRO, pp. 28–29.
233 RCVMHS, Virtual Help—The Future of Digital Services Roundtable: Record of Proceedings, 2020.
234 RCVMHS, Virtual Help—The Future of Digital Services Roundtable: Record of Proceedings.
235 Helen Christensen and others, E-Mental Health Services in Australia 2014: Current and Future, 2014, p. 10.
236 Christensen and others, pp. 3–4 and 10–11.
237 Commonwealth Department of Health, Initial Submission to the Productivity Commission Inquiry into Mental
Health, 2019, pp. 22–23.
238 E-Mental Health in Practice, Submission in Response to the Draft Report, Chapter 6: Supported Online Treatment
from the Productivity Commission Inquiry into Mental Health, 2020, p. 2.
239 Productivity Commission, Mental Health Inquiry Report, Volume 2, pp. 666–667.
240 EY, Submission in Response to the Draft Report from the Productivity Commission Inquiry into Mental Health,
2020, p. 4.
241 Productivity Commission, Mental Health Inquiry Report, Volume 2, p. 667.
242 Productivity Commission, Mental Health Inquiry Report, Volume 2, p. 667.
243 Gooding and Maker, p. 4.
244 Michael Bauer and others, ‘Ethical Perspectives on Recommending Digital Technology for Patients with Mental
Illness’, International Journal of Bipolar Disorders, 5.6 (2017), 1–14, (pp. 6 and 8).
245 Witness Statement of Dr Elizabeth Deveny, para. 106.
246 Quinn Grundy and others, Finding Peace of Mind: Navigating the Marketplace of Mental Health Apps, 2017, p. 12.
247 Gooding, p. 4.
248 Witness Statement of Dr Piers Gooding, para. 27.
249 Witness Statement of Kym Peake, 2020, para. 295.
250 CSIRO, p. 10.
251 Gooding and Maker, p. 4.
252 Grundy and others, pp. 7–10.
253 Gooding and Maker, p. 4.
254 Gooding and Maker, p. 4.
255 Brigid Richmond, A Day in the Life of Data: Removing the Opacity Surrounding the Data Collection, Sharing and
Use Environment in Australia, 2019, p. 37.
256 Bucci, Schwannauer and Berry, pp. 289–290.
257 RCVMHS, Innovation Roundtable—Hosted by LaunchVic: Record of Proceedings, 2020.
258 RCVMHS, Innovation Roundtable—Hosted by LaunchVic: Record of Proceedings.
259 Witness Statement of Professor Mario Alvarez-Jimenez, para. 38.
260 Department of Health and Human Services, pp. v–vii.
261 Ministry of Health, Ontario, p. 12.
262 Ministry of Health, Ontario, p. 64.
263 Ministry of Health, Ontario, p. 64.
264 Ministry of Health, Ontario, p. 64.
265 Ministry of Health, Ontario, p. 64..
266 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 192.
267 Daniel S. Johnston, ‘Digital Maturity: Are We Ready to Use Technology in the NHS?’, Future Hospital Journal, 4.3
(2017), 189–192 (p. 191).
268 Johnston, p. 191.
269 Johnston, pp. 190–191.

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270 Johnston, p. 191.

271 Witness Statement of Terry Symonds, 2 November 2020, para. 302(a).
272 Witness Statement of Terry Symonds, para. 302(b).
273 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 189.
274 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 181.
275 Johnston, p. 191.
276 Witness Statement of Shane Solomon, para. 57.
277 Orygen, Online Innovation Supports the Mental Health of Young Victorians, <www.orygen.org.au/About/News-And-
Events/2020/Online-innovation-supports-the-mental-health-of-yo>, [accessed 8 October 2020].
278 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 190.
279 Witness Statement of Dr Piers Gooding, paras. 27–28.
280 RCVMHS, Virtual Help—The Future of Digital Services Roundtable: Record of Proceedings.
281 Witness Statement of Dr Piers Gooding, para. 29.
282 Witness Statement of Kym Peake, 2020, para. 290.
283 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 189.
284 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 189.
285 Victorian Government, Victorian Budget 2020–21: Service Delivery: Budget Paper No. 3, 2020, p. 65.
286 Victorian Government, Victorian Budget 2020–21: Service Delivery: Budget Paper No. 3, p. 65.

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Chapter 35

New approaches
to information
management

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Recommendation 61:

Sharing mental health

and wellbeing information
The Royal Commission recommends that the Victorian Government:

1. develop policies, standards and protocols to enable the effective, safe and efficient
collection and sharing of mental health and wellbeing information.
2. s
et expectations that mental health and wellbeing services will provide opportunities
for consumers to contribute to the information held about them and gain easy
access to it.
3. c
ollaborate with consumers to introduce a consent-driven approach to information
sharing with mental health and wellbeing services and individuals outside of the mental
health and wellbeing system.

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Recommendation 62:

Contemporary
information architecture
The Royal Commission recommends that the Victorian Government:

1. d
evelop, fund and implement modern infrastructure for Information and
Communications Technology (ICT) systems, including:

a. a
new statewide Electronic Mental Health and Wellbeing Record for mental health
and wellbeing services to replace the current Client Management Interface/
Operational Data Store (CMI/ODS) system;
b. a
review of data items currently required for service delivery and system
administration, the removal of unused items and the addition of new items that
accurately reflect mental health service activity and consumer outcomes;
c. a
new Mental Health Information and Data Exchange that allows interoperability
between the proposed Mental Health and Wellbeing Record and other services’
major ICT systems to support information sharing in real time within and across
services and sectors;
d. a
new user-friendly online consumer portal (web and mobile) connected to the
Mental Health Information and Data Exchange that allows consumers to view key
information about themselves and authorise sharing of information with members
of their care team, including families, carers and supporters; and
e. a
comprehensive data repository and associated clinical registries for mental health
(within the recommended Mental Health Information and Data Exchange) that will
support outcome measurement, future service planning, continuous improvement
and mental health research.

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35.1  A contemporary approach

to information management
As the mental health and wellbeing system becomes increasingly person‑centred, consumers
will have more opportunity to lead and actively participate in their own care, and to receive
high‑quality, safe and effective treatment, care and support. Contemporary approaches
to the collection, use and sharing of information—with the needs and preferences of the
consumer always in mind—will be one of the bedrocks that will allow this to happen.

In the digital age, a person’s mental health and wellbeing information should be easily
accessible to them—they should be able to get it quickly and efficiently.1 Consumers having
access to their own information helps to build their trust and supports them to participate in
discussions and decisions about their treatment, care and support.2

Organisations and service providers involved in a person’s treatment, care and support need
to have access to appropriate, timely and accurate information to provide services that are
compassionate, safe, effective and coordinated. The flow of this information helps consumers
move seamlessly and safely within and between services.3 Families, carers and supporters
also need access to appropriate information to support people living with mental illness or
psychological distress.

A wide range of information is collected and used across the mental health system. This
information is often sensitive and personal to the consumer. It needs to be collected and used
to help service providers and mental health workers understand a consumer’s experiences,
needs and preferences, and to work closely with them to identify and deliver appropriate
treatment, care and support. Information and data are also needed to help services and
the system to remain accountable for their performance, to forecast and respond to future
service demand, and to continually improve the quality of service delivery.4

The National Mental Health Commission and the Productivity Commission recently highlighted
the need for future mental health services and systems to be underpinned by high‑quality
information and data to support better consumer outcomes and good system administration.5

In the new mental health and wellbeing system, many people will receive treatment, care and
support that requires some form of collaboration across multiple services and individuals.
This might include health services, emergency departments, acute inpatient services,
community‑based services and GPs, as well as families, carers and supporters and other
services.6 The effective, safe and efficient collection, use and sharing of information is
essential for this to occur.

Figure 35.1 outlines some of the Commission’s major reform objectives that will need to be
supported by contemporary approaches to information collection, use and sharing.

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Figure 35.1:  Reform objectives requiring contemporary information management

These approaches must be supported and enabled through state‑of‑the‑art technology,

systems and structures. Systems and structures should ensure organisations and individuals
have access to the information they need, when they need it.

They should help people move within and between services seamlessly and should provide for
consumers to actively participate in and collaboratively manage their own mental health and
wellbeing. They should also enable families, carers and supporters to undertake their caring
roles effectively.

Figure 35.2 describes the Commission’s vision for a connected and high‑performing mental
health and wellbeing system across all age cohorts that uses contemporary approaches
to information collection, use and sharing to improve consumer experiences, outcomes
and service and system performance. These arrangements will improve communication
and collaboration between service providers, improve service efficiency through reduced
administrative burden and duplication of effort, and improve decision making. Most
importantly, they will improve the consumer experience.

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Figure 35.2:  A reformed system requiring contemporary information management

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Royal Commission into Victoria’s Mental Health System

35.1.1  Upholding privacy, safety and trust

Mental health information7 generally refers to information or an opinion about a consumer’s
physical, mental or psychological health, a health service provided, a consumer’s expressed
wishes about future service delivery, and personal information collected to provide health
services.8 Information from others—including families, carers and supporters—may also be
included in mental health information, where appropriate.

Mental health information can take a number of forms but includes items such as assessment
results, clinical notes, medication information, admission and discharge summary
information, prior service delivery history and interventions received, consumer advance
statements—which are formal documents that set out consumer preferences for treatment,
care and support—and consumer outcomes.

There is widespread support for better information sharing across the system from
consumers, families, carers and supporters and service providers, but they have emphasised
that ensuring people’s privacy and safety must remain a major feature of the future system.9
Mr Dave Peters, a witness before the Commission, said that while information sharing is
beneficial, unfortunately the stigma of mental illness means that too much sharing may have
a negative impact on consumers:

there’s a real opportunity to use the available information to benefit both the
patient and the clinician by preventing repeated tests and helping prevent a need
for the patient to tell their history again. Unfortunately there is a risk that too much
shared information could impair the diagnostic process due to the stigma related to
mental illness.10

The Commission understands that some mental health information is very sensitive. While
increased information sharing will most likely improve the continuity of treatment, care and
support and consumer experiences, when implementing the recommended reforms, the
Victorian Government will need to carefully consider the extent to which different types of
information are collected, stored and shared, to uphold consumer privacy and safety.11

New information cultures and systems will need to strongly protect consumers’ information
and privacy, and promote trust in information sharing. Some information may continue to
be shared as it currently is. Examples include existing permissions that allow for workers
on the same team to communicate about a consumer in their treatment, care and support
or existing obligations to provide information to relevant authorities when legally required.
However, to allow services to deliver integrated and seamless treatment, care and support,
the movement of information around the mental health and wellbeing system must change.

Supported by appropriate permissions and protections, new approaches to the collection, use
and sharing of information can enable:

• consumer access to their own information to help them to manage their own
treatment, care and support and increase their agency—that is, their sense of control
over their own lives
• sharing information within a mental health and wellbeing service to deliver treatment,
care and support

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• sharing information between different mental health and other health services (such
as physical health, general practice or allied health) to enable effective consumer
transitions
• where appropriate and necessary, sharing basic information with broader service
systems such as community providers and other services including alcohol and other
drug, housing, employment and other support services
• improved system administration and accountability
• more effective continuous improvement of services, interventions and the system
as a whole.

Box 35.1 discusses these purposes in more detail.

Box 35.1:  Definitions, purposes and types of information

collection, use and sharing in mental health

Information collection, use and sharing

For the purpose of this report, ‘information collection’ refers to mental health
information a service provider or entity may collect as part of its organisational
functions. ‘Use’ refers to the use of information for the purpose of delivering
services to consumers, or for directly related purposes such as administration.

‘Use’ also refers to who can see and use this information, and in what
circumstances. It includes the protections and securities put in place to ensure
privacy standards are met.

‘Information sharing’ broadly refers to the disclosure of information to another

worker, provider, organisation or person for the purposes of treatment, care and
support or accountability.12

Purpose and types of information collection, use and sharing

in mental health

For service delivery

Information is used in the delivery and use of services, both by consumers and by
service providers.

Consumers access and use their own health information so they can make
decisions about their treatment, care and support. Having timely access to
complete information helps them to manage their own recovery.

Mental health and wellbeing workers and services also use consumer mental
health records to document a consumer’s health history, medications, diagnoses,
treatment plans and clinical notes and outcomes.

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Royal Commission into Victoria’s Mental Health System

Different information can be shared across services for several purposes:

• Information sharing within mental health and wellbeing services—this

involves sharing of information between practitioners and workers
within the same service for the purpose of service delivery. This generally
includes clinical notes, consumer outcomes and consumer preferences and
service history.
• Information sharing between mental health services and general health
services—this includes the sharing of information between different
mental health and wellbeing services and general health services for the
purpose of service delivery and consumer transitions. For example, as
a consumer moves through the system, some information may need to
pass from the emergency department to an inpatient unit, and then to a
community‑based mental health and wellbeing service when the consumer
is discharged. Information may also need to be shared with general health
services at various points.
• Information sharing with services outside the state mental health and
wellbeing system—this includes sharing of some basic information (such as
discharge information or medications) with a range of other providers that
may be involved in a person’s care. For example, primary and secondary
services such as GPs, allied health workers and private psychologists or
psychiatrists. In certain circumstances, or with consent, some information
might also be relevant to providing wellbeing supports and other services,
such as housing, justice, legal aid and family violence.
• Information sharing with individuals—this includes sharing of information
with families, carers and supporters involved in a person’s care.

For service and system administration and continuous improvement

At the state and national levels, comprehensive and high‑quality data helps
to determine areas of need, service and program effectiveness and efficiency,
and areas for policy improvement and funding reform. It also informs strong
compliance and accountability regimes.13

At the service level, access to data and information, coupled with data analytics
capability, helps with performance monitoring and supports clinical practice and
the management, delivery and evaluation of health services.14 Comprehensive
outcomes‑based data also helps inform research into the effectiveness of
interventions, both for specific groups of people and at the system level.15

This type of information use includes:

• clinical registries and data repositories to monitor and inform service

intervention improvements
• data collections and datasets to inform administrative responsibilities
(state and national).

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35.2  Features of contemporary

information collection, use and sharing
A range of features are essential to contemporary information collection, use and sharing
in the mental health and wellbeing system. These features support honest and open
communication, collaboration, consumer agency and effective, efficient and safe information
sharing. The Commission considers that the following features should be central to
information management in the mental health and wellbeing system:

• clarity about the purpose of information collection, use and sharing—to ensure
everyone understands how, when and why information should be captured or shared,
and to recognise that each person involved in someone’s treatment, care and support
has information that others may need to know
• open sharing of information between workers, services and organisations, governed by
clear and transparent permissions that describe what information should be shared
and in which circumstances—noting that not all information needs to be shared
with everyone
• increased consumer access to their own mental health and wellbeing information, and
the ability for consumers to contribute to their own records, where appropriate—noting
that there are circumstances when this cannot occur due to risk to the person or others
• an open and respectful mindset when recording information about consumers
• privacy and credentialling arrangements to ensure mental health and wellbeing
information is only shared with those who need to see it—with clear and simple consent
policies and mechanisms that give as much control as possible to consumers in terms
of who sees what information, and in which circumstances
• information is recorded securely in electronic form in interoperable systems, and there
are mechanisms in place to enable efficient and appropriate flow of information within
and between services
• progressive improvement based on experience of what works and what does not.

Figure 35.3 summarises these features.

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Figure 35.3:  Features of contemporary information management in mental health and wellbeing

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35.3  The challenges of information

collection, use and sharing
Over recent years, Victoria has attempted to improve information sharing between service
providers to support services to connect with each other, deliver high‑quality treatment, care
and support for consumers, and to reduce safety risks.16

However, the Commission found there are limitations in the sharing of information within
mental health services, between mental health services and with other organisations involved
in a person’s treatment, care and support.17 These limitations have a negative impact on
consumer experiences and outcomes. There are also challenges associated with consumers
accessing their own mental health information, and families, carers and supporters often
struggle to access appropriate information when needed.

The Commission’s interim report emphasised that, at the service and system levels,
‘inadequacies in information gathering and data collection across all levels of the mental
health system also constrain system accountability and monitoring’.18 It observed that
‘information and data are incomplete, inconsistent and often inaccessible, lacking a
nationally consistent approach to outcomes measurement, collection and use’.19

The Commission is concerned about the negative impacts these challenges are having
on consumers, families, carers, supporters, service providers and mental health workers,
and the system.

35.3.1  The harmful impacts of limited information sharing

Many people told the Commission that the lack of information sharing between individuals
and services in the mental health system places the burden of communication, information
collection and follow‑up largely onto consumers, families, carers and supporters. This results in
people having to explain their circumstances over and over, which can be traumatic.

In their witness statement, Mary and Jacob Corbett described how the lack of information
sharing between services, and even within services, forces people to explain their
circumstances time and again, negatively affecting the experience of receiving treatment,
care and support:

In our experience, there is not very good communication and sharing of information
between services, or even within the same service. For example, if a person goes to
hospital in an ambulance, the paramedics ask questions, which the patient answers.
Then the receptionist asks the same questions, then the doctor on the ward asks the
same questions, and so on and so on. Even before a patient is settled in their room, they
may have been asked the same questions by five or six different people. It is obviously
counterproductive to have to relive the traumatic experiences over and over, especially
when you are just freshly sick and disoriented.20

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Similar challenges occur as consumers move between public mental health services and
primary and secondary mental health and related services, sometimes negatively affecting
their wellbeing. For example, one person shared the damaging impact poor information
sharing between her hospital team and private psychiatrist had on her physical health:

And well, for me, a really big thing happened earlier this year. It was between the hospital
service and my private psychiatrist. Because I had a really rare reaction to medication.
And the hospital didn’t communicate what actually happened to my psychiatrist,
even though they said they did. And he put me on another medication, which caused
the same thing. And I’ve now been in a wheelchair since February, because they didn’t
communicate …21

The experience of limited information sharing was echoed by a number of consumers, who
cited examples of poor information sharing between their GP and public area mental health
services, between community‑based services and inpatient services, and between public
mental health and private services.22

Area mental health services noted that a reliance on paper‑based files and the lack of
sufficiently accessible and joined‑up clinical information sharing systems often meant
lengthy delays in receiving information from other services. As a result, consumers may be
discharged without a comprehensive assessment, forced to wait for lengthy periods in the
emergency department, or given inadequate responses.23

Mental health services also currently have no way of identifying how many times a person
may have attended an emergency department or called for help.24 This means that
someone’s deterioration may go unnoticed for long periods of time.25 Limited information
sharing between different services means that services are often unaware of a person’s
history. One carer informed the Commission about the terrible result the lack of access to
prior information had on her daughter’s life. Unfortunately, her experience reflected others
across the system:

There needs to be access to a patient’s file across all mental health institutions. My
daughter was taken to [hospital] … in a heightened state claiming she wanted to die, she
was assessed, and released. She was found dead in the city at 7am. My first question to
the Detective who told me this was ‘Why was she released when she had a long history
of [mental health] treatment and had only been in Psych Ward 4 days earlier?’ You can
only imagine my disbelief when informed that they had no way of knowing unless told by
the patient or someone with them.26

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Outdated systems and processes also affect people’s privacy and safety. The Commission
heard from a consumer who had suffered a severe breach of privacy due to a lack of secure
and efficient digital sharing capability:

My private doctor doesn’t have a fax. They wouldn’t take an email, they wouldn’t
take a phone call. And so I ended up getting my parents to print a copy so that I could
physically hand it to the treating team so that they would have the relevant information.
However, what happened in that exchange was that my parents, particularly my mother
read it, which is a huge violation of privacy, but also there’s a history of family violence
there. And so it really wasn’t an appropriate mechanism at all for that information
sharing to occur between my private doctor and the public hospital treating team. And
it was incredibly disempowering that there was no efficient, streamlined way for that
information sharing to occur, it was detrimental to my treatment, it was detrimental for
them not to have that contextual information.27

While the lack of information sharing within and between services is a considerable challenge,
the Commission was equally concerned with the apparent lack of consumer access to their
own mental health information. Consumers indicated that they want to access their own
information for a number of reasons, including as closure for past circumstances, as a means
of understanding their experiences, to assist their recovery and to challenge the record.28
However, they often struggle to access their mental health information when they need it.

One person told Victoria Legal Aid that the lack of access to their clinical notes made it
challenging to exercise their rights:

It’s not easy to exercise your rights when you don’t have any of the information you
need. In there I tried to access my own clinical notes, to understand what they were
saying about me. Instead they said that I would have to go through this rigorous
freedom of information process, to access the notes that they were writing about me! I
just gave up. For someone doing worse than me, this would be impossible.29

Access to appropriate levels of information was also a big challenge for families, carers
and supporters. The Victorian Government’s submission to the Productivity Commission
recognised that families, carers and supporters are often not provided with relevant
information or excluded from the treatment of their loved ones.30 Chapter 19: Valuing and
supporting families, carers and supporters discusses these information challenges in detail
and highlights that the lack of information sharing with families, carers and supporters
makes it incredibly challenging for them to undertake their caring role successfully, and can
make them feel alienated.31 One carer at a roundtable told the Commission that they felt
excluded from the person’s care team:

they weren’t sharing [information] and they weren’t treating me as an important part
of the team.32

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Another carer noted that the role carers play is not acknowledged, and the information that
they hold is not always valued:

the communication just isn’t there, that acknowledgement that we have, I suppose
wisdom and resilience as a consequence of the role that we play is overlooked
and I think there’s the potential for allyship and collaboration, [but] the lack of
communication just means that that’s always missed.33

The Commission understands there are many reasons for the current challenges with the
collection, use and sharing of information outlined above, including:

• the system being under pressure, which compromises the creation of

information‑oriented cultures and relationships, where curiosity and collaboration are
supported and rewarded
• complex legislation and policy environments that limit, or are perceived to limit,
sharing and collaboration
• outdated ICT systems that hinder effective information collection, use and sharing.34

The Productivity Commission’s Mental Health Inquiry Report also found culture, legislation
and ICT systems to be the major barriers preventing routine sharing of information in mental
health to enable continuity of care.35 The Royal Commission into Family Violence found
similar barriers to information collection, use and sharing, indicating that these types of
issues are common in large and complex systems.36

35.3.2  A lack of an information sharing culture

The current service system cultures do not promote collaboration, information sharing or
openness. Siloed approaches to working, in which services do not communicate with each
other, appear to have contributed to this situation, as have the stigma around mental illness
and confusion about what information can be shared. These circumstances have existed for
a long time, and the result is a culture in which information is tightly held.

The Commission was told that there is a lack of engagement with information and a general
lack of collaboration and process. A consumer at a roundtable said that there needs to be a
culture that promotes reading and engaging with information:

we can develop the best and incredibly well designed information sharing system with
state of the art technology, that will only be as good as the way that it’s implemented
… any system that we design in terms of information sharing is only as good as people
actually having time to read it, having a culture around the importance of reading it,
and engaging with it.37

However, some consumers told the Commission that there appears to be a lack of willingness
or time on the part of mental health workers to read consumer information, resulting in
consumers continually being asked the same questions, or receiving ineffective responses:

My experience is that staff often don’t have time to read information, even when it’s
there. So even when I’ve had an advance directive on file … my experience is that even
though they’re legally required to the overwhelming majority of staff don’t read it.38

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The Commission also understands that practitioners may refuse to share information either
within or between services. Sometimes this is due to a lack of trust, or different attitudes
and beliefs between different workforces; or a fear of causing further stigma for a consumer.39
The stigma surrounding mental illness means that clinicians, often with the best of intentions,
may be unwilling to share sensitive information with other members of the team, or with
other services.40

Dr Stuart Lewena, Director of Emergency Medicine at The Royal Children’s Hospital, cited
the lack of willingness of some service providers to collaborate as a central cause of poor
information sharing. He also noted that a reluctance to collaborate can be caused by
practitioners disagreeing about diagnosis or approaches to treatment, care and support:

The predominant barrier that needs to be overcome … is the apparent lack of willingness
of some stakeholders to engage and collaborate with one another. My observations of
this as a stakeholder who interacts with the mental health system and its practitioners
are that this manifests in … some mental health care providers refusing to share patient
information [and] clinical disagreements between mental health care providers on
diagnosis and treatment methodology for particular shared patients.41

One consumer at a roundtable told the Commission that staff appeared to disregard
important information about her health from another clinical expert:

I’m actually trying to share clinical information and they don’t even care about clinical
information from another … experienced doctor who’s known me for five years.42

Consumers also felt that the mental health system in general was unwilling to share notes
with them, and that the systems and processes in place to access their own information are
cumbersome and ineffective.43

Placing a freedom of information request with services to receive information, and associated
lengthy delays, can be a cause of strain for consumers. One consumer was sent only
screenshots from clinical systems that were impossible to decipher:

I asked for all my medical records from the [hospital] … all they did was give me
screenshots of my admissions, there were no notes, there was no nothing. Like, you know,
no one wants to share your information, like I can’t even get my own information.44

Another consumer described receiving heavily redacted copies of their own records, which
caused great anxiety and fear that there was something terrible in the record that they
should not see.45 Under the Freedom of Information Act 1982 (Vic), service providers can be
legally obliged to redact information for many reasons, including when the provider believes
(on reasonable grounds) that providing the information to the person would pose a serious
threat to the life or health of the person or another person.46 However, some consumers
find this practice to be inconsistent across and within services, and that it is overused and
excludes them from understanding their service history.47

While consumers recognised that there may be some circumstances where information
sharing may need to be delayed, or where information may not be shared, they argued that
in most cases people should be able to know and see what is written about them.

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One roundtable participant said:

I think, there needs to be a culture shift in the mental health system, to see that in the
majority of situations, consumers should know what is written about them, and have the
opportunity to disagree or to clarify information.48

When consumers did receive their records, they stated that the information was often written
in clinical language that was not accessible to them, or felt disrespectful, judgemental and
hurtful.49 One roundtable participant said that the notes they received were unprofessional:

the notes that were written about me some of them were bordering on insulting, some
of them are bordering on incredibly disrespectful. Very judgmental language, language
that was very much not recovery‑oriented … it was like reading a playbook of insults.
And I was like, this is supposed to be my medical record. This is absurd … how can this
mental health service legitimately claim that this is a medical record when parts of it
read like a schoolyard series of insults.50

Consumers were adamant that there needs to be a cultural shift in the recording of
information that places the person at the centre, is therapeutic and captures the consumer’s
own voice. Another person noted the need for more accessible language in records:

An issue with the clinical notes at the moment, is that they’re so clinical and written in
a language that individuals don’t use those words to describe themselves … And I think
there’s sometimes potentially a case for writing two notes, one in a clinical language and
another one, that it’s an accessible language for consumers to process themselves, or
just ditch the clinical language in the first place and have all of it written in accessible
language. So I think it’s a change in the way things are written rather than a not
sharing at all.51

The Commission expects that in the future mental health and wellbeing system, information
recorded about, and provided to, consumers will be accessible and understandable. The
Commission also understands the critical importance of accurate, clear and clinically
relevant notes to support practitioners to appropriately assess people experiencing mental
illness or psychological distress, diagnose their conditions and provide them with treatment,
care and support. In many cases, this requires the creation of notes that contain technical
language and apply commonly used terms or phrases. As these notes are used across
periods of time and sometimes shared between practitioners, there needs to be a level of
consistency and clinical rigour to ensure they can be used to deliver high‑quality treatment,
care and support.

Providers are required to capture relevant and sufficient content to safely perform their roles,
and regulated practitioners and clinicians are required to take appropriate, relevant and
accurate notes as part of their professional registration.52 Consumers should be supported to
understand any technical references in their notes and, where feasible, safe and appropriate,
information should be recorded in an accessible format. Information should always be
communicated in a respectful way.

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The Commission was also told that it is rare for consumers to be able to contribute to their
own mental health records, which reduces their sense of agency and their control over their
own treatment, care and support.53 Consumers were clear that, wherever possible, they would
like the opportunity to contribute to their own records.54 A person told Victoria Legal Aid that
their inability to contribute risked organisations forming a negative perception of them:

I have no meaningful way to be involved in how these are written, to see them or to
correct them when they are wrong. This then goes to places like the [Mental Health
Tribunal] where it defames me.55

Families, carers and supporters said that some service providers may use privacy and
confidentiality obligations as a way to exclude them from accessing relevant information,56
stating that there is an overall culture of not including consumers’ support networks in
consultations.57 The Commission understands that there are a number of potential factors
leading to such practices. For example:

• Many professionals are trained to work with consumers in a one‑on‑one context, which
means they might not have the information needs of families, carers and supporters
front of mind.
• Professional codes of ethics generally impose confidentiality as a fundamental
principle.
• The management of legal or other risks within services may require them to routinely
reinforce the importance of privacy and confidentiality.
• Time and capacity to think and work with an individual and their families, carers and
supporters is limited in the current system.
• Sometimes families, carers and supporters can be perceived as ‘difficult’ because
they have had to advocate strongly for the person they care for in a broken system.
As a result, some practitioners are reluctant to engage with them or do not feel
confident doing so.

35.3.3  Complex and confusing legislative,

regulatory and policy frameworks
The current legislative, regulatory and policy frameworks that guide the collection, use and
sharing of mental health information are extremely complex, and are challenging to navigate
and understand. The Commission’s assessment of the frameworks and legislation that deal
with information sharing indicates a number of challenges including:

• the complexity and number of legislative, regulatory and policy frameworks, which
creates uncertainty about which regimes or rules apply, to whom and in what
circumstances
• uncertainty creating a default position of privacy and confidentiality, even when
information may be able to be shared
• a focus on the obligations of individual service providers, rather than consumer needs,
which means that information sharing across multiple providers is difficult, despite
information being essential for consumers accessing mental health services and
consumers often requesting it.

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While intended to protect consumers’ privacy and safety, the current frameworks have been
established with a focus on what information individual service providers can collect, use and
share. These rules are important but do not always support an integrated and responsive
approach that focuses on individual consumers and their preferences or needs. Consumers,
families, carers, supporters and service providers are sometimes restricted from accessing or
receiving information that may improve treatment, care and support.

Information collection, use and sharing is already taking place under current arrangements.
However, given the scale of change needed to establish the new mental health and wellbeing
system, changes to legislation, protocols, processes and practices will be required to ensure
information can flow safely and effectively. The Commission has identified several areas
where change will likely be needed.

Consumers’ access to their own information

Under the Health Records Act 2001 (Vic), consumers have a right of access to their own
information,58 subject to requirements in the Freedom of Information Act. A consumer's request
to access their information is often initiated through a freedom of information request to their
relevant mental health service provider. Consumers are required to submit a separate freedom
of information request for each health service provider they require information from and may
also need to pay a fee for the administrative cost of gathering or preparing the information.59

Under current laws, service providers must not give a person access to their mental
health information if the organisation believes on reasonable grounds that providing the
information would pose a serious threat to the life or health of the individual or any other
person,60 or where the information has been handed over to the organisation in confidence.61
This may result in the redaction of certain information provided to a consumer.

When consumers try to access their own information as allowed by legislation, this process
can take a very long time. It is not an efficient way for consumers to check that the health
information about them is accurate, up to date and fairly records their position and views.
There are also inconsistent approaches in the redaction of information.

So, while current legislation does not in itself appear to be a barrier to consumers accessing
their own records, it is clear that the means of gaining this access are cumbersome and
require reform. New practices and processes are needed to improve consumers’ ability to
easily gain access to their mental health information, supported by technology.

Progress towards this objective is already underway in parts of the mental health system. For
example, a number of services are trialling new consumer portals that improve consumer and
practitioner access to information.62 Epic at Melbourne Health is introducing a portal called
the Health Hub. Professor George Braitberg AM, Executive Director of Strategy, Quality and
Improvement at The Royal Melbourne Hospital, said that the hub will:

allow medical practitioners and patients to access their records securely and document
any changes to their treatment plan, review their admissions to hospital, pathology
results and upcoming appointments, and facilitate correspondence between medical
practitioners.63

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Family, carer and supporter access to information

As discussed in Chapter 19: Valuing and supporting families, carers and supporters, current
legislative and policy arrangements set out several provisions that allow families, carers
and supporters to access some consumer mental health information that will allow them to
carry out their caring role.64 A range of different provisions exist for different circumstances,
but Chapter 19 acknowledges that these provisions are complex, not always well understood
by service providers, families, carers and supporters, and so are not always effective. The
Commission has suggested that these provisions be simplified as part of legislative change
recommended in Chapter 26: Rebalancing mental health laws—a new Mental Health and
Wellbeing Act, and has recommended new standards to help guide information sharing in the
mental health and wellbeing system.

Highly complex and constrained collection, use and sharing of information

for service delivery

Under current arrangements in Victoria, designated mental health services65 can collect and
use consumer mental health information and share it between one another for the purpose of
service delivery.66

However, for other types of health service providers, such as primary and secondary
providers, emergency services and non‑government organisations, information collection,
use and sharing is more complex. Different frameworks govern their ability to collect, receive,
use and share information in different circumstances.

This complexity can make it difficult for workers and services to understand which regime
applies to which organisation, and in what circumstances. Even when legislation does not
formally restrict the collection or disclosure of information, its complexity can mean that
services avoid collecting and sharing information out of an abundance of caution.67

35.3.4  Implications arising from future reforms

Victoria’s reformed mental health and wellbeing system will be large and adaptive due to its
size and the number of service offerings. There will continue to be diverse service types and
providers, and over time this mix may evolve further. This will mean that much work will need
to be done, potentially on an ongoing basis, to ensure information is managed and shared in
a way that supports system objectives and individual consumers’ needs.

In this section, the Commission outlines its reforms and an assessment of the limitations of
current information arrangements. This analysis is indicative rather than comprehensive
because the operational requirements of the recommended reforms will need to be further
considered before they are implemented.

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New approaches to assessment and referral

As part of its broader reforms, the Commission has recommended—in Chapter 8: Finding and
accessing treatment, care and support—that any service provider can refer people to Local
Mental Health and Wellbeing Services and that medical practitioners can refer people to Area
Mental Health and Wellbeing Services.

Electronic referrals will be the preferred form of non‑crisis referrals to Local Mental Health
and Wellbeing Services, Area Mental Health and Wellbeing Services and statewide services,
allowing information about the consumer to be received by the services, with the consumer’s
consent, in a standard form. Medical practitioners will collect basic referral information on
the consumer’s health and mental health, as well as other information about their needs and
preferences to facilitate effective transitions.

While legislation already allows medical practitioners to make referrals into public mental
health services, new referral processes, guidelines and policies will need to be established
to ensure consistent referral approaches across the state. However, legislative change
may be required to support circumstances where other service providers may be making a
referral into Local Mental Health and Wellbeing Services. As described in Chapter 8: Finding
and accessing treatment, care and support, the Department of Health should develop and
promote an access policy for mental health and wellbeing services. This will promote a clear
and consistent approach to managing referrals and people’s initial contact with mental
health and wellbeing services.

The legislation will also likely need to be amended to allow for electronic collection of
information and referral into mental health and wellbeing services, as the current scope of
electronic information collection and sharing appears limited.

Delivery of connected treatment, care and support with seamless transitions

In the future mental health and wellbeing system, services and practitioners will be expected
to work in a much more multidisciplinary and integrated way, both within and between
services. The Commission intends that alcohol and other drug services, physical health
services, allied health services, wellbeing services, primary and secondary services and a
range of other services will work much more closely together to provide people with effective
treatment, care and support. Functions that have predominantly been the responsibility of
area mental health services may also be undertaken by a broader range of practitioners
and service providers including non‑government organisations. Chapter 5: A responsive and
integrated system, and Chapter 6: The pillars of the new service system—community‑based
mental health and wellbeing services describe these arrangements in detail.

Current arrangements already support the legal sharing of information between primary
and secondary service providers and new mental health and wellbeing services, but there
does not appear to be a uniform process or approach to information sharing with these
organisations, or at least there is little evidence of this. New information sharing protocols
and practices will be needed between mental health and wellbeing services and primary
or secondary providers to allow for Area Mental Health and Wellbeing Services to provide
secondary consultation, and for shared treatment, care and support arrangements,
where relevant.

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As part of its recommended multidisciplinary and integrated service arrangements, the

Commission is also proposing that Local Mental Health and Wellbeing Services and Area
Mental Health and Wellbeing Services work much more closely with alcohol and other
drug services and broader social supports including housing, family violence prevention,
employment services and others. Current legislation is unlikely to allow for the collection, use
and sharing of information between mental health and wellbeing services and these other
services where these practices are not captured under either the Health Records Act or
the Mental Health Act 2014 (Vic). Without legislative change, the new system will struggle to
offer consumers the joined‑up and integrated treatment, care and support the Commission
envisages. Revised approaches and clear permissions will likely be necessary to ensure
relevant information flows between these organisations, without affecting consumer privacy
and safety.

Provision of effective crisis services and responses

The Commission’s proposed crisis reforms mean that Ambulance Victoria will take a lead
role in responding to consumers experiencing a mental health crisis, as outlined in Chapter
9: Crisis and emergency responses. Police will be involved only where necessary to protect
people’s safety.

The Commission understands that under current arrangements, Ambulance Victoria and
emergency departments not operated by a designated mental health service are unable
to access any consumer mental health information directly.68 Mr Simon Thomson, Regional
Director of Ambulance Victoria, told the Commission that ambulance workers are unable to
access even basic consumer data, such as whether they have a mental health care plan or an
existing provider, to determine the best approach to respond to a person in crisis.69

He indicated that to effectively respond to consumers, Ambulance Victoria requires direct

access to basic consumer mental health information.70 Similarly, area mental health services
have indicated that all emergency departments would benefit from being able to access
basic consumer information to help form an appropriate response for them.71

While these organisations can receive consumer health information from a designated
mental health service under certain circumstances prescribed by the Mental Health Act,
the database that holds this information must be accessed by someone from a designated
mental health service.72

The Commission is supportive of emergency responders having access to the information

they need to deliver an effective response, but understands the importance of skilled people
receiving and interpreting information. Without this skill, there is a risk that judgements
may be made about a person’s behaviour or circumstances based on their history of mental
illness or psychological distress.73 Legislative change is likely needed to allow Ambulance
Victoria to access the information it needs to undertake its lead role effectively, and
appropriate mental health clinical supports, as recommended in Chapter 9: Crisis and
emergency responses, should be in place to help first responders to interpret the information
sensitively and appropriately.

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Better coordination and collaboration for people needing ongoing intensive

treatment, care and support

The Commission recognises that some people who seek treatment, care and support from
multiple service providers find it very challenging to access responsive and coordinated
service responses. Chapter 5: A responsive and integrated system recommends establishing
new Regional Multiagency Panels to support collaboration and accountability of service
provision to some adults, older adults and children and young people who need ongoing
intensive treatment, care and support. Regional Multiagency Panels will support people and
the services that provide treatment, care and support to this cohort to ensure they are held
accountable and collaborate in their work. Participants in Regional Multiagency Panels will be
diverse and will vary, but may include clinical, housing and wellbeing support services.

Health, mental health and other information about people’s needs and preferences will need to
be shared between representatives of participating providers to support good outcomes. Some
information will also need to be shared between Regional Multiagency Panels, the Multiple and
Complex Needs Initiative (MACNI) and the Victorian Fixed Threat Assessment Centre, especially
when community safety is a concern.

In relation to MACNI, there is already some legislative provision to allow for the collection
and sharing of health and personal information between service providers involved in
an approved care plan for eligible people with multiple or complex needs.74 However,
this legislation is not broad enough to allow information to be collected and shared for
all consumers receiving support under the panels, and was crafted specifically for the
MACNI program.

The Regional Multiagency Panel regime will accordingly require its own legislated information
sharing regime. This regime can be modelled on the MACNI information sharing regime
but will need to be crafted to allow sharing of information between those people and
organisations involved in providing treatment, care and support to these cohorts. Ensuring
appropriate delegations and protocols are in place to protect privacy and sensitive
information will also be important.

Better support for people in or leaving prison who are living with mental illness
or psychological distress

The Commission understands that much stronger collaboration and coordination needs to
occur between services and organisations detaining (due to their actual or alleged offending)
people living with mental illness or psychological distress in the criminal and youth justice
systems, particularly people who require ongoing intensive treatment, care and support.

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Currently, there is a failure to share critically important mental health and health information
across relevant settings and providers, and this greatly impedes the capacity to deliver
effective mental health services in custodial settings, including prisons and police cells. The
Coroners Court of Victoria has previously recommended that better information sharing
occurs between institutional parties involved in a prisoner’s treatment, care and support and
transitions, including Victoria Police, corrections (in both custodial and community settings)
and mental health services.75

While it is not appropriate for officers or general staff to have access to a person’s clinical
information, good communication between these agencies in certain circumstances is
paramount—such as when a person is at high risk of self‑harm or suicide or when they have
a need for intensive treatment, care and support.76 Better coordination of referrals at key
transition points is important, including when someone is transferred from police custody
to a correctional facility, and when they are released from a custodial setting and require
treatment, care and support from an area mental health service.77 Some level of electronic
access to mental health and other information will be necessary to achieve this.

This sharing of limited information will likely require legislative changes and very clear
protocols and delegations to ensure access to any sensitive information is tightly held.
There are already examples in other sectors, including the family violence information
sharing reforms and the Criminal Justice Enhancement Program, which have implemented
comprehensive access rules and oversight arrangements to ensure only authorised people
can view sensitive information.78

The Commission is also recommending the creation of a program to help transition people
in prison living with mental illness or psychological distress who require ongoing intensive
treatment, care and support to Area Mental Health and Wellbeing Services, as outlined in
Chapter 23: Improving mental health outcomes across the criminal justice, forensic mental
health and youth justice systems. The Commission was told of a need to improve information
sharing between health services in prisons and community and mental health and wellbeing
services when someone is released from prison. For example, limited information may be
shared about a person’s medical treatment in prison, and discharge summaries can be lost.79
Privacy and confidentiality concerns may also limit shared information between agencies.80

Improvements in protocols, practice and enabling technology will be needed to support

better and more effective transitions for all consumers transferring from prison to an Area
Mental Health and Wellbeing Service.

Chapter 30: Overseeing the safety and quality of services, suggests that the new mental
health quality and safety functions include oversight of the mental health of prisoners to
ensure they receive high‑quality mental health treatment, care and support. This will require
prisoner mental health information to be shared as part of custodial mental health oversight
arrangements. New legislation will be necessary to allow this to occur.

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Service and system administration

As noted earlier, information and data are also routinely collected and shared for service and
system administration purposes. Current legislation allows de‑identified information—that
is, information that does not identify an individual—to be used for research in the public
interest. It can also be used for service planning, funding, management, monitoring and
improvement. Thoroughly assessing and revising, if necessary, existing policy and legislative
provisions will be critical to ensure they enable the generation of more advanced information,
including better datasets and new clinical registries to inform research, evaluation,
continuous improvement and system accountability.

Further, the Commission is concerned that the current definition of electronic collection and
use of health information in the Mental Health Act81 appears to be outdated and no longer
fit for purpose. Future electronic information management and sharing arrangements will
require amendments to this section of the legislation so it enables the information sharing
arrangements and associated ICT solutions proposed by the Commission to fulfil their
intended purposes.

35.3.5  A lack of effective ICT systems

Digital technology allows information and data to be effectively captured and transferred,
thus supporting good practice and service delivery and allowing performance and outcomes
to be monitored, analysed and improved.82

Multiple service providers have told the Commission that antiquated ICT systems and
inefficient information collection and sharing arrangements limit their capacity to provide
good‑quality treatment, care and support and to work within and across services in an
integrated and collaborative way.83 Mr Terry Symonds, then Deputy Secretary of Health and
Wellbeing at the former Department of Health and Human Services, also noted that ‘[c]urrent
IT infrastructure and data capabilities for mental health are unable to support contemporary
best practice approaches to service delivery in Victoria.’84

While digital records and electronic sharing of information can raise privacy concerns for
some people, consumers at a roundtable indicated that they would ultimately prefer some
form of efficient electronic system:

I think we have the technology to abate any concern about [privacy]. And I think the
other mechanisms that we have, like printing out paper, like faxing, like phone calls, all of
that is very non‑ideal and an electronic system that is secure is much preferable to that.85

Both nationally and internationally, there is a push to digitise information and records to improve
information sharing through connected systems. The main drivers of this change have been:

• greater efficiency through automating previously manual processes

• ease of access to people’s clinical information among multiple people involved in their
treatment, care and support
• improved safety and quality by reducing human error
• consumer empowerment by increasing access to their own information
• improved data for management, funding and accountability.

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Box 35.2 outlines some of the major trends.

Box 35.2:  Major trends in the use of technology to

improve information collection, use and sharing

Electronic medical records systems are now commonplace in health care globally
and nationally. For example, New South Wales, Queensland and South Australia
are progressively implementing electronic medical records systems across all
their major hospitals.86 More than 60 per cent of Victoria’s public hospital beds
have electronic medical record systems, and this is being extended.87

Nationally, the Commonwealth Government has introduced the My Health

Record system, which covers 90 per cent of Australians.88 It contains important
basic health information about consumers, such as their medications, a list
of Medicare‑billing practitioners, immunisations they have had, some of their
hospital discharge summaries and, increasingly, their pathology results.89

Recognising that a person’s health information is kept in multiple places,

governments are increasingly moving to connect systems.90 There is a global
trend towards ‘interoperability’, which accepts that there will never be one,
all‑encompassing electronic medical record system, and that information
needs to be shared between the different electronic health record systems and
providers to improve consumer treatment, care and support.91

In 2019, the Australian Health Ministers Advisory Council endorsed the National
Health Interoperability Roadmap, which sets out a framework for sharing of
health information between all parts of health care—primary, specialist and
inpatient, whether public or private.92 All states and territories are moving to
support this framework.93

Internationally, electronic medical records are increasingly shared among

interoperable systems. For example, Ontario Health teams in Canada have
implemented the award‑winning Health Report Manager system, which integrates
health team records with primary care electronic records.94 It is designed to
improve communication among healthcare providers by enabling services to
receive patient reports, such as discharge summaries, from hospitals and other
healthcare facilities directly into their own electronic medical records systems.95

Private sector organisations are also starting to share records or communication

platforms.96

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The health ICT landscape

In Victoria, most public mental health service delivery occurs within the broader health
service system. The state’s hospital and community health ICT systems are advanced. The
Victorian Government’s investment through the 2016 Digitising Health strategy has focused
on implementing new clinical systems and electronic medical records within hospitals;
sector‑wide shared clinical information, integration and interoperability in line with state and
national standards; and international good practice.97

As a result of this and health service investment, more than 60 per cent of acute hospitals
have advanced digital health records and information management systems and most
others are upgrading their systems.98 Victoria allows health services to choose their own
electronic medical record systems in line with a set of standards, leading to implementation
of different systems in different hospitals.99

Despite the ICT advancements in general health, the Commission was told that investments
have not always incorporated mental health service needs.100 As a result, the use and type of
electronic health records for acute and community‑based mental health services are mixed.101
The major hospital records include records for acute inpatient mental health wards.102 In a
limited number of cases, these electronic records have been configured to include mental
health services in community‑based settings.103 For example, one metropolitan hospital has
adapted its system to operate in the adult community mental health service, informing both
inpatient and community mental health staff about what is happening with consumers.104

However, most community‑based mental health services do not have an electronic health
record system, instead recording information on paper and transferring it by fax.105 The
Commission is aware that some of these services are moving to adopt electronic records, but
on the whole there are very limited digital records in community‑based mental health services.

There are also multiple patient management systems in primary and secondary health
services. For example, there is widespread adoption of clinical information systems in general
practice.106 Private specialists are increasingly using patient management systems as the
market responds to differing needs in this sector.107

While the switch to digital records is a positive step, hospital electronic medical records only
enable intrahospital information capture and sharing.108 They do not allow for sharing with
other services and sectors.109

A tailored but outdated approach in mental health

Existing area mental health services use a longstanding statewide data system called the
Clinical Management Interface/Operational Data Store (CMI/ODS) to record and share
basic information about registered consumers.110 CMI/ODS records a range of mental
health–related data including details of consumer admissions to bed‑based services,
clinical contacts in the community, consumer outcome measures (consumer and clinician
completed) and details of consumers receiving compulsory treatment under the Mental
Health Act.111 The Department of Health manages the system, and area mental health services
input their data into the server to report to the department.112

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The advantages of CMI/ODS are that it generates a unique statewide identifier for registered
consumers, which lets any area mental health service access information, in real time,
recorded about that person, regardless of which service they use.113 It ensures the legal basis
for providing treatment on a compulsory basis is evident to all services and provides the
mechanism for the services to meet their departmental data reporting obligations, as well
as reporting obligations to the Chief Psychiatrist and Mental Health Tribunal.114 Registered
consumers are those who have been admitted into a public mental health service for
treatment, care and support.

CMI/ODS does not at this time capture information on non‑registered consumers.115

Non‑registered consumers include people who have made contact with a service (either
through the emergency department or triage), but who have not been assessed as needing
or able to be treated by that service.116 This means that it is currently not possible for services
to see any information or prior history for a person who has sought help previously but not
received public services.117 General emergency department workers and non‑designated
health service providers are not able to access CMI/ODS information.118

While the statewide view of mental health consumers available in CMI/ODS is useful, several
area mental health services and others told the Commission that the information in the
system is largely administrative and is not used for day‑to‑day service delivery.119 They also
noted that it has very limited capacity to record or share clinical notes.120 Its clinical use is
limited to the initial assessment of a person, for discovering whether the person is already
registered in the mental health system, and for reporting to the department.121

Other aspects of CMI/ODS are also less than ideal. The data for CMI/ODS is collected
manually by the mental health worker and entered into the system by administrative staff.122
This is inefficient, and not consistent with how modern health record systems work, such as
those used in hospitals and by GPs, where a person’s data is entered directly into the system
and replaces paper records.

Further, CMI/ODS also does not allow for any sharing of information with other health
systems, including hospital electronic records or primary care systems.123 This means that
electronic information sharing within and between mental health providers is very limited,
and that CMI/ODS is not useful as a tool to support integration of physical and mental health
treatment, care and support across sectors. There is currently no other statewide information
sharing system that enables quick and secure sharing of records.124

NorthWestern Mental Health described the challenges of current ICT arrangements, which
limit both information capture and information sharing:

Whilst the [department’s] statewide mental health information system, Client

Management Interface/Operational Data Store (CMI/ODS) is a valuable asset, it has
significant limitations and does not appear to have a system development life cycle
aligned to the service delivery changes. There is functionality that is either not used or
no longer meets the services’ needs. This issue along with the lack of interoperability
with other health service systems creates inefficiencies resulting in local bespoke
systems being developed.125

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Monash Health also stated that data system management needs to be refocused towards
clinical care, and that better use must be made of available technology and digital health
solutions to improve information collection and sharing:

The current data system for Victoria, CMI, fundamentally restricts clinical care. It is a
legacy system and should be retired so that best practice clinical care is facilitated
by, not dictated by, the data system. Technology needs to assist the clinical process
and allow flexibility in the clinical work as well as in the design of services. We need
to move on from CMI to something much simpler and flexible. Currently, CMI is highly
prescriptive, encourages silos in the way it opens and closes cases, and increases
likelihood of people falling through the cracks rather than decreasing the likelihood
which was intended. It should be designed from the bottom up to assist clinicians.126

Area mental health services advised the Commission that due to the lack of shared electronic
records, they mostly use phone, fax or hard copy to share clinical records during transitions
and care coordination.127 In regional settings, a courier is sometimes needed to transport
paper information.128

This reliance on fax and phone‑based communication is inefficient and ineffective.

Consumers must merely hope that service providers have contacted their next service and
passed on relevant information, and that this information has been received and accepted.129

Moreover, because CMI/ODS and service provider electronic records do not currently connect
to one another, this leads to duplication of data entry, inefficiency and increased chance of
data entry error.130 Duplication of entry can also result in human error inputs, which may put
consumers at physical or non‑physical risk.131

Bendigo Health recognised that services have had to implement bespoke systems to capture
data but that this duplicates data entry and requires extra resources:

While use of the system [CMI/ODS] is mandated, the system lacks functionality and
usability is poor. In addition, ability to access live data from the system at a service level
is limited. As a result, [designated mental health services] are utilising bespoke systems
in addition to CMI/ODS to allow for local analysis and interrogation of data to both
monitor performance and inform service provision, duplicating both data collection and
resource effort as system integration with CMI/ODS is not supported.132

Outside of state mental health services, there is virtually no electronic connectivity between
primary and secondary care and the state system, which solely relies on fax, phone and
paper‑based sharing of clinical information.133 This lack of even the most basic secure
electronic messaging is a major barrier to sharing information and limits providers’ ability to
seek important information about a consumer.

Primary Health Networks described how challenging this lack of integrated systems is
when trying to help consumers move between service sectors. Primary Health Network
representatives suggested that Victoria is difficult because it does not have statewide
data infrastructure to manage patient flow.134 They argued that Victoria needs a statewide
architecture to maximise data and improve how patient information is shared so consumers
do not need to tell their story over and over again.135

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Dr Elizabeth Deveny, CEO of South Eastern Melbourne Primary Health Network, also said that
electronic information sharing is important for ensuring smooth transitions between public
mental health services and GPs:

In my view, digital technologies and e‑records in relation to a person’s care are

necessary when a consumer of mental health services may move from an inpatient
stay in hospital to a GP and to other community service providers. Having one source
of readily accessible information about a consumer is very important particularly in
relation to stepped models of care and the main game, which is keeping people well and
out of hospital.136

The Commission is concerned that the current disconnect, variability and inefficiency of ICT
systems and processes hampers the ability of service providers to capture, use and share
consumer information effectively. At the core of the issue, the Commission was told that
services needed to ‘demolish the fax machine’ and implement more contemporary systems
that support better consumer experiences and safety.137

35.3.6  A lack of data to drive service and system improvements

Better collection and dissemination of mental health data is also critical for improving the
performance of mental health and wellbeing services and the system, and can help translate
research into practice.138 However, current mental health data collection arrangements and
systems are not fit for purpose.

As noted above, CMI/ODS is the primary source of data for Victorian mental health
services. It does have some advantages: it enables longitudinal studies—that is, studies
over a period of time—of consumer outcomes and it contains some rich data.139 However,
Mr Symonds noted that mental health data collection, analysis, synthesis and dissemination
are all hampered by the CMI/ODS system, which has limited use in informing performance
monitoring and improvement.140 Mr Symonds, Mr Shane Solomon (Partner of Caligo Health
and giving evidence in a personal capacity), and others have noted major issues with current
data collection including:

• a lack of data about effective interventions141

• a focus on collecting data for compliance purposes rather than to inform future planning
and monitor service quality and efficacy (including treatment and intervention data)142
• a lack of information on all people who access public specialist mental health services
(rather than just registered clients, who are only recorded in the system after they are
deemed eligible for mental health services)143
• poor or inconsistent data collection on specific consumer cohorts and their outcomes144
• poor and inconsistent triage data that limits understanding of who is or is not able to
access public specialist mental health services145
• the way in which contacts are recorded, which may underreport true hours of contact146
• limited capacity to share information for quality and safety purposes147
• inconsistent collection of data on diverse communities, reducing transparency
regarding the use of mental health services and associated outcomes in diverse
communities, and the capacity to plan for and respond to their needs.148

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At the service level, the Commission was told that CMI/ODS does not allow service providers
to easily see their own data that they have inputted into the system, nor produce live reports
and graphs to track their performance and outcomes.149 Ms Karyn Cook, Executive Director
of Mental Health Services at Warrnambool Community Health’s South West Healthcare,
said that improving digital infrastructure and capability could improve data analytics,
research and innovation, including by enabling ‘services to access their own data, monitor
performance easily, and slice it to suit their own strategic planning’.150

At the system level, Mr Solomon noted that there is scant evidence to indicate what type
of service model and level of intervention works best.151 He indicated there is little focus
on recording and describing the types of services consumers receive and linking that
to outcomes, which is important for evaluating the effectiveness of different models of
treatment, care and support.152 Instead, mental health services tend to record only basic
output data such as number of bed days or number of phone calls made.153 Mr Symonds also
said that the Victorian Government holds multiple valuable datasets that could be better
linked to improve evidence‑based policy, planning and service delivery.154

The Victorian Government noted that a ‘redesign of the client management system
would facilitate the delivery of high‑quality services’, 155 and that new data standards and
mechanisms would be beneficial to improve system administration and accountability:

In particular, development of a centralised live information system would support more

active statewide monitoring, stronger forecasting and more timely quality improvement.
Further, a redeveloped system would reduce clinician documentation burden which
currently requires data entry across multiple systems. In addition, centralised triage
data capture at the gateway to the specialist service system would support stronger
oversight of specialist mental health service access. This would make it possible to
determine whether people are being appropriately triaged, or whether they are not
being admitted to services because of pressures on the available resources. The Royal
Commission also has an opportunity to recommend that the Victorian Government
refine data collection definitions, methodologies and mechanisms to collect
standardized and comparable data on outcomes.156

Mr Solomon suggested that such changes to the type of data that is collected, and how,
are necessary for researchers to undertake more effective studies. He also stated that the
impact of existing institutes and new ones like the Collaborative Centre for Mental Health and
Wellbeing will depend on getting access to this type of data.157

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Professor Suresh Sundram, Head of the Department of Psychiatry at the School of Clinical
Sciences at Monash University and Director of Research at Monash Health Mental Health
Program, told the Commission in a personal capacity that ‘[a] clinical registry concept
similar to that successfully established in oncology is required in the public mental health
system.’158 Clinical registries collect health‑related information to monitor outcomes from
various interventions and guide service and system improvements.159 He noted that this
would allow ‘the collection of high‑quality clinical data for every individual who engages with
the public mental health system, and long‑term data associated with that individual’.160 This
data could be linked with demographic data, creating a record of outcomes associated with
interventions and socioeconomic variables.161 Professor Sundram suggested that a mental
health registry would be invaluable for research into effective interventions, and could reduce
ineffective practices.162

Many other services and universities also suggested to the Commission that access to
better data is essential to create a learning culture. For instance, in its submission, the Adult
Psychiatric Imperative noted that linking health datasets with other national and state
datasets is critical to help determine factors that contribute to and precipitate mental illness,
as well as to determine outcomes from interventions.163 However, there is currently limited ability
to link data and information across different sectors and with primary mental health services.164

The Commission considers that a new approach to information collection, use and sharing
is needed to support measuring outcomes, system accountability, research, innovation
and evaluation.

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35.4  A pathway forward for

information management
Victoria’s mental health and wellbeing system must be supported by more efficient and
innovative use of information and data to improve service delivery, the consumer experience
and system administration.

The Commission believes that the Victorian Government needs to shift the culture of
information collection and sharing in mental health from one of risk avoidance and silos, to
one of collaboration, openness and presumed but protected access.

To achieve this, there need to be major reforms that give priority to:

• new mechanisms that will contribute to an appropriate culture of openness based on

informed consent, protections, and clear policies, standards, protocols and delegations
• enhancing technology and information architecture to improve information collection,
use and sharing
• refocusing information and data on people, and on consumer outcomes and
experiences in particular.

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35.5  Creating a culture of

openness and co-ownership
Consumers, service providers and families, carers and supporters have expressed the desire
for a much more open, collaborative and seamless culture of information collection, use
and sharing. This will lead to better service delivery and improved consumer outcomes and
experiences.

To achieve this, the Commission recommends that the Victorian Government establishes the
following approaches to promote a more open culture of recording and sharing information
between mental health and wellbeing service providers and with consumers, families, carers
and supporters.

35.5.1  New policies, standards and protocols

for information collection, use and sharing
Relevant policy documents, strategies and performance and accountability frameworks should
clearly communicate the need for new approaches to information collection, use and sharing.
They should enable the effective, safe and efficient collection and sharing of mental health and
wellbeing information between individuals and service providers who have a genuine need to
know such information for the purpose of service delivery, safety or good system administration.

These documents should not be prescriptive in nature but should clearly emphasise the
expectation that new ways of collecting, using and sharing information are required to ensure:

• they reflect the principle of ‘open and presumed but protected access’, including
transparency about how information is being collected, used and shared
• they reflect existing and emerging information security standards and arrangements
that ensure data and information is secure and only accessed by those who need to see it
• integrated and joined‑up care between workers, within and between services and for
continuity of care
• seamless consumer transitions that reduce the burden on consumers, families, carers
and supporters to have to tell their story multiple times or to bear the responsibility of
maintaining and transferring their health information
• improved service monitoring, performance and accountability
• enhanced outcome measurement, research and innovation to deliver better
interventions and outcomes over time.

The complexity of the mental health and wellbeing system also means that clear guidance
about information management is needed for service providers, consumers, families, carers
and supporters. The Victorian Government should develop and release standards developed
in consultation with consumers, families, carers and supporters to ensure they effectively
respond to the priority needs of each.

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Wherever appropriate, specific protocols should also be implemented to guide the delivery
of information‑related reforms, including for referral approaches into Local Mental Health
and Wellbeing Services and Area Mental Health and Wellbeing Services, and transitions
and shared care arrangements between primary and secondary care providers and mental
health and wellbeing services.

Alongside the protocols and standards, the government should also ensure information
security arrangements are in place to inform the proper access, use and protection of
consumer mental health information. Mr Symonds noted that ‘records must be kept, stored
and used in ways that protect and preserve the safety of clients’.165 This should include that
the system and services have appropriate delegations, permissions and operational policies
to make sure only those who need to view information can access it and are responsible for
safe and proper management of the information. Oversight of information sharing will also
be critical. The Victorian Information Commissioner has combined oversight of information
access, information privacy and data protection.166 The Information Commissioner has the
power to undertake inquiries and audits into organisations’ compliance with relevant privacy
regulation and legislation—for example, its 2017 Review of Information Governance in the
then Department of Health and Human Services.167 Together, strong information security
arrangements and oversight functions should provide openness of information sharing,
clarity of roles and responsibilities, and consequences for breaches.

The Commission recognises that in some instances legislative change will be necessary
to modernise information sharing arrangements and to ensure the future system delivers
contemporary services. Removing legislative and regulatory barriers that prevent open
sharing of information between service providers, while retaining appropriate consumer and
worker rights and protections, is critical.

The new Mental Health and Wellbeing Act recommended in Chapter 26: Rebalancing
mental health laws—a new Mental Health and Wellbeing Act will specify the ways in which
information should be collected and used for the purpose of: electronic collection, use and
sharing; service provision; system administration; accountability; measuring outcomes; and
conducting research and evaluation.

Outside of this Act, the Victorian Government will need to ensure it regularly reviews and
revises other legislative frameworks that may affect the ability to use or share information in
line with the new reforms.

35.5.2  Consumer contributions and access to information

At the service level, leaders should also promote a more open culture of information collection
and sharing with consumers. The Victorian Government should set clear expectations of
mental health and wellbeing services that includes:

• recording information that is sensitive, factual and assumes from the beginning that
consumers will be able to access it
• providing consumers with opportunities to contribute to the information held about
them, where appropriate
• supporting consumers to easily access their own information.

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35.5.3  A consent-driven approach

Informed consumer consent is essential to a culture of open information collection and
sharing. During consultations, consumers were clear that consent is important to them, but
that it should not get in the way of sharing limited basic information that improves their
outcomes and experiences.168

Comprehensive consent arrangements will help ensure consumer privacy and increase their
agency, and such arrangements will help service providers understand when information
should and should not be shared. Consent is important to ensure a consumer‑centric system
of service delivery.

The Victorian Government should, without removing existing permissions, co‑design and
implement a consumer consent approach with consumers. This system will inform service
providers, families, carers and supporters involved in a person’s treatment, care and support
about how consumer information can be collected, used and shared. Importantly, the consent
approach needs to adequately consider and capture the information needs of parents
and guardians of children and young people, as well as legal guardians responsible for the
wellbeing of some adult consumers. Parents of children need access to their child’s mental
health and wellbeing information, and many parents and guardians of young people play
an active role in that person’s treatment, care and support. Consent arrangements should
consider these needs and transition arrangements while protecting the privacy and safety of
individuals.

The consent system should also build on information currently available in CMI/ODS (it would not
scale back existing access permissions) and should inform the implementation and accessibility
of information in the Mental Health Information and Data Exchange proposed in section 35.6.3.
The consent system would be aligned to and work within the parameters of future legislation.

This consent system will give consumers more power over their information and will support
them in working closely with their treatment, care and support team in the way that best
suits them. This will also mean families, carers and supporters can get more detailed
information where a consumer requests it, more easily.

35.5.4  Implementation and phasing considerations

The Victorian Government should establish the policy directions and protocols that will
guide information collection, use and sharing across all mental health and wellbeing reforms.
This should include the development and release of the new standards for information
sharing to help guide service providers, consumers, families, carers and supporters.
These policies, protocols and standards should be regularly reviewed and updated. The
consumer consent approach and associated permissions should be co‑designed and
established as part of this work.

At the same time, legislative change will occur through establishing a new Act to enable
effective and efficient information sharing aligned with the new reforms. Over time,
legislation, including the new Act and other relevant legislation, should be routinely reviewed
to ensure it enables effective and safe information collection, use and sharing.

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35.6  New ICT systems and infrastructure

While legislative and policy changes are necessary to establish a new information culture,
modern ICT systems will be critical to implementing the efficient collection, use and flow of
information in line with the protections and permissions discussed previously.

A number of service providers and experts have suggested that new information systems are
needed to allow for better service delivery to consumers, and better performance monitoring.
Sharing of records has been raised as a major enabler of increased safety and improved
service delivery.169 St Vincent’s Hospital Melbourne suggested that connected ICT systems will
help to improve service delivery:

Ensuring integrated ICT systems where information is readily accessible across [area
mental health services] is important. Solutions that clinicians can readily access,
wherever they see the consumer, as well as technology that allows people to connect,
would improve service delivery and efficiency.170

The Commonwealth Scientific and Industrial Research Organisation (CSIRO) noted that
electronic information sharing systems are critical to providing more holistic, precise and
preventative health responses in future health systems.171 They indicated that these systems
can improve consumer outcomes by ‘enabling safer medicines management, improving
care coordination, and helping inform treatment decisions’.172 The Productivity Commission
found that expanding the use of digital records in mental health services would facilitate
a much better consumer experience and improve information sharing.173 The Productivity
Commission recommended that My Health Record, the national shared health record,
provides a good platform for this information sharing to occur.174

The Commission is broadly supportive of this approach, and concurs that digital records and
systems need to be better used to allow for contemporary service delivery. The Commission
also notes that My Health Record is one valuable tool for sharing some mental health
information, and that its utility in the sector will improve as more services adopt it.

However, the Commission notes that many of Victoria’s mental health services do not even
have the basic electronic records systems nor functionality to connect to My Health Record,
which itself does not have the full functionality needed to effectively and appropriately collect
and share the full range of information needed to deliver comprehensive mental health
services. As Peninsula Health stated, ‘My Health Record does not appear to have materially
assisted with information sharing in the mental health sector.’175

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Mr Symonds noted that significant investment is needed in Victoria to redesign how the
system manages case information and service delivery, as well as collection of data for
administrative purposes.176 Without this investment, the mental health and wellbeing system
will continue to fall further behind general health and will not deliver on its reform objectives.

As previously described, Victoria has the existing CMI/ODS system that allows public mental
health services to share some information on common registered consumers, and also
includes a central statewide data store of information. However, the system is outdated and
does not have many of the features needed for contemporary information collection, use and
sharing, including:

• the ability to record clinical notes and access clinical information between mental
health services
• the ability to see prior service delivery information on non‑registered people—that
is, those people who have sought treatment, care and support from a mental health
provider but have not been accepted
• the ability to easily and efficiently generate performance and service reports to
improve service responses.

There is also limited ICT capacity to allow connectivity or sharing of information between
public mental health and wellbeing services and other health services involved in a
person’s day‑to‑day treatment, care and support, including GPs, private psychologists and
psychiatrists and allied health workers.

To this end, the Victorian Government should fund and establish new state‑of‑the‑art
technology infrastructure and systems for mental health and wellbeing that at a minimum
will ensure:

• information is recorded efficiently and safely in electronic form, removing the reliance
on paper records, reducing double entry of information, and creating easily retrievable
information for providers
• it is easy to access and share information—providers should not have to search
through multiple applications to find essential information
• the technology solution draws on digital information already available in other systems,
with a focus on what information is to be shared with other permitted parties
• recording and visibility of consistent information across all mental health and wellbeing
systems and service streams, with appropriate parameters and protections in place
• systems are designed to progressively improve over time, based on experience of what
works and what does not and on evolving needs
• the design and oversight of the projects and ICT systems are controlled by those
people with most to gain from their success, including frontline mental health and
wellbeing workers, consumers and families, carers and supporters.

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The Commission recommends introducing three new major ICT components to achieve this:

• A new statewide Electronic Mental Health and Wellbeing Record—this would be for
all public mental health and wellbeing services (including services within the infant,
child and youth mental health and wellbeing system, and those within the adult and
older adult mental health and wellbeing system), which will replace the current CMI/
ODS system. For community mental health and wellbeing services, which are almost
all still paper‑and fax‑based, using the record will bring their mental health service
digitisation to a level comparable to that in hospitals and primary health care. The new
record will interoperate with hospitals that have electronic medical records, and so
avoid duplication of data entry and resources.
• A new Mental Health Information and Data Exchange—this would allow for sharing
of information outside of public mental health and wellbeing services, such as GPs
and community mental health and wellbeing services, where appropriate. This could
happen for one of two purposes: to facilitate service delivery or to enable access to
deidentified data for research and administrative purposes.
• A new consumer portal to allow consumers to easily access their own information.

Figure 35.4 summarises the Commission’s intent for the new ICT arrangements, noting that
the Victorian Government should partner with consumers, families, carers, supporters, service
providers and frontline workers to design and implement all of the priority initiatives listed.

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Figure 35.4:  Conceptual map—ICT arrangements for information collection, use and sharing
in the mental health and wellbeing system

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35.6.1  A new statewide Electronic Mental

Health and Wellbeing Record
Digital records are essential to support good consumer treatment, care and support, choice
and easy transitions. As a core component of the new system, community‑based mental
health and wellbeing service providers need access to digital records to deliver on their core
functions. However, community‑based mental health settings are where digital mental health
records are currently missing. The Department of Health should rectify this situation so these
services can provide more seamless transitions, joined‑up care and efficient practice. It will
also reduce the need for consumers to tell multiple providers their story and will help mitigate
risks of harm.

The department should develop and implement a contemporary Electronic Mental Health
and Wellbeing Record using new governance arrangements outlined later in this chapter. This
will replace the current CMI/ODS system for all public mental health and wellbeing service
providers that do not currently have an electronic medical record with a mental health
module. Mental health and wellbeing services that do have a mental health module as part of
their electronic medical record should have the opportunity (and be encouraged) to opt in if
they wish.

This record should be a single system created and maintained for the whole state and across
age cohorts to ensure sustainability and consistency across the sector. Functionality should
be progressively developed in line with consumer and service provider needs, but initially this
record should hold the basic information that mental health and wellbeing workers need to
provide treatment, care and support. This functionality would include:

• demographic information
• contacts
• intervention codes and services delivered
• outcomes and experience measurements
• bookings
• full clinical notes recording capacity
• visible access to consumer advance statements and preferences
• ability to generate performance reports.

The record should retain the strengths of CMI/ODS, including statewide look‑up capacity, a
single consumer record number, initial assessment functionality and data definitions (where
appropriate).177

Over time, further functionality could be added to support activity such as prescribing and
ordering tests or medications. The design of the record should allow for easy updating and
for new modules and functions to be progressively added as new needs arise over time.

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While the record should support service delivery to consumers of all ages, the Victorian
Government should ensure appropriate parameters are in place that control viewing of specific
information based, for example, on age at the time of treatment or other factors that may
affect consumer privacy. These issues should be the focus of the co‑design process outlined in
section 35.6.7 involving consumers, families, carers, supporters and service providers.

The new Electronic Mental Health and Wellbeing Record should be cloud‑based to support a
mobile workforce and interoperable with existing and emerging hospital electronic medical
records and other patient management systems. It should build on existing state platforms
wherever possible.

35.6.2  A review and update of currently recorded data items

Improved service delivery and better system administration, research, innovation and
evaluation require improved data and better analytical capability.

The Victorian Government should undertake a comprehensive review of the current data
being captured by public mental health services. It should reduce those items that are not
routinely used and add items that better reflect mental health activity and consumer mental
health and wellbeing outcomes.

This review should be led in consultation with service providers and other experts to identify
unnecessary measures and to determine the most appropriate new items for inclusion.

At a minimum, new items should:

• capture accurate counting of hours of client‑related work

• record contacts for ‘unregistered’ clients, aligned with the new statewide triage data
collection approach recommended in Chapter 8: Finding and accessing treatment,
care and support
• include ‘intervention codes’ to classify what services are offered to clients across
different types of treatment, care and support (this is important for future research into
which interventions are most effective)
• capture consumer and clinician completed outcome and experiences measures, and
any family, carer and supporter measures developed
• include fully integrated and improved assessment and referral data to better
understand who is trying to access the system and who is not receiving support,
including a range of demographic data such as (but not limited to) diversity and
socioeconomic status
• capture consumer needs that would lead to better experience and outcomes (such as
accessibility requirements and language support needs)
• capture accurate clinical costings data to price mental health and wellbeing services
effectively.

The new data items will give service providers more comprehensive information about the
types of services their consumers are receiving and their effectiveness. This information will
support optimum service model design in the future.

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New data items and standards will also improve system capability to undertake service
planning, commissioning and performance monitoring. A better understanding of which
interventions work will guide more targeted research and investment, leading to improved
treatment and intervention models for mental health and wellbeing.

The Victorian Government should consider the way the system operates in the context of
broader data management approaches for health and also community services.

35.6.3  A new Mental Health Information and Data Exchange

A new Mental Health Information and Data Exchange is needed to allow sharing of core
information beyond the public community and inpatient mental health service system
with the broader range of those services involved in a person’s recovery, including private
psychiatrists and psychologists, GPs, and non‑government organisations.

The Victorian Government should, through the governance model outlined below, fund and
implement development of the new Mental Health Information and Data Exchange.

The Mental Health Information and Data Exchange should allow interoperability between the
recommended Electronic Mental Health and Wellbeing Record and other major systems such
as (but not limited to) hospital electronic medical records, GP practice management systems,
specialist psychiatric and psychologist systems and My Health Record.

The Mental Health Information and Data Exchange would not share every piece of
information about a consumer with everyone who has access to it. It should have a ‘clinical
viewer’ function that allows each relevant service or worker to view relevant information
easily. It should provide basic information needed for other entities to provide treatment, care
and support effectively and in line with consumer preferences.

In the beginning, the Mental Health Information and Data Exchange should allow for seamless
viewing and sharing of information between Victorian funded mental health and wellbeing
services and health entities directly involved in responding to mental health and wellbeing
needs, including emergency departments and emergency responders. This does not mean
that every party should have access to every part of a consumer’s record, but they should be
able to view the fundamental information they need to deliver their services effectively.

Once established, the Mental Health Information and Data Exchange should allow for sharing
of some relevant information between funded mental health and wellbeing services and
primary and secondary service providers (for example, GPs, allied health workers and private
psychiatrists and psychologists). This access should be informed by the consumer consent
approach previously proposed, and should be controlled by the consumer.

Over time, the Mental Health Information and Data Exchange could be expanded to include
a more diverse range of services involved in a person’s treatment, care and support, such
as alcohol and other drug services and housing. Sharing of information with these entities
should be limited to only the information that they need to know to deliver services effectively,
informed by strict information privacy and security protocols and protections, and strictly
informed by consumer consent.

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Appropriate privacy and security protections should be applied to the Mental Health
Information and Data Exchange to ensure consumer privacy, safety and trust, and strict
delegations should ensure that only authorised personnel can view relevant information
about the consumer. Transparent communication about how and when information is used
and shared should also be available to consumers and service providers. Mr Peters told the
Commission that people’s lack of confidence in being able to control digital information
sharing can be a hindrance to adopting digital records.178 Mr Peters noted that the system
needs ‘strict controls around information sharing’, and in addition, that information should
wherever possible, be shared with consent, and should be opt in.179

Ms Kym Peake, then Secretary of the former Department of Health and Human Services,
also said that electronic records should have strong safeguards, and that it is important to
cultivate trust in consumers that their privacy will be maintained.180 Ms Peake noted that
actively engaging with the public about how their information will be used, communicating
the benefits of information sharing, and listening and responding to concerns will help to
build support and trust for electronic systems and processes.181

The Victorian Government should ensure the Mental Health Information and Data Exchange
is designed in partnership with service users and service providers to help build usability and
trust as recommended in the implementation approach below. The Department of Health
should also consider establishing a clear communication plan to promote the features of the
new system to consumers and service providers that explains the benefits of the new system
and implementation timelines. Communication materials should also be transparent about how
information will be collected, shared and protected across all parts of the system.

While the Mental Health Information and Data Exchange is being developed, secure
messaging capability should be implemented to allow basic information such as discharge
summaries and medication lists to be sent to a consumer’s primary and secondary care
team, including GPs and private providers. This will allow basic information to be shared
quickly and securely while the larger systems are being developed. This approach should
also be used to support electronic referrals between medical practitioners and Local Mental
Health and Wellbeing Services and Area Mental Health and Wellbeing Services in the interim.

In the immediate term, while the Mental Health Information and Data Exchange is being
established, the Victorian Government should also provide Ambulance Victoria with access
to the basic information they need from CMI/ODS so they can effectively respond to mental
health crises in the community. As described in Chapter 9: Crisis and emergency responses,
while Ambulance Victoria should have access to this information, mental health expertise
should also be offered to the attending responders to help them understand the context
and implications of this information for the consumer, and therefore the most appropriate
response. Chapter 9 outlines the current trial of such an approach that Ambulance Victoria is
undertaking in partnership with Eastern Health.182

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35.6.4  A new data repository, clinical registries

and accessible information
The aggregate data collected under the new Mental Health Information and Data Exchange
should be used to create a central data repository of all mental health and wellbeing
information. There are a number of purposes for this data repository.

The information in the data repository should inform the suite of mental health and wellbeing
data collections the Department of Health collects to advise on policy and service design,
and performance monitoring and accountability.

Information in the data repository should also be made available to services to help them
benchmark and improve their own performance.

The Mental Health Information and Data Exchange and data repository should also be used
to house and inform new clinical registries for mental health and wellbeing that will support
future research and practice translation. These registries should be available to authorised
researchers, advocates, innovators, service providers, practitioners, consumers, families,
carers and supporters, as well as some government organisations, to inform service and
system improvements. Strict permissions should apply to the registries to ensure information
is only accessible to those who need to see it.

De‑identified information from the Mental Health Information and Data Exchange—that
is, information that is aggregated to a level that ensures that an individual cannot be
identified—should also be used to create new public dashboards that provide the general
community with access to regularly updated data on a range of mental health and wellbeing
system performance and outcome measures. This will help to improve transparency
about system performance. Figure 35.5 outlines the major features a new data repository
should have.

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Figure 35.5:  Features of the mental health and wellbeing data repository

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35.6.5  A new, user-friendly consumer digital portal

The Victorian Government should establish a new user‑friendly online consumer portal
linked to the Mental Health Information and Data Exchange. This portal will be web and
mobile friendly and will allow consumers to quickly and easily view crucial information about
themselves and to authorise sharing of that information with members of their treatment,
care and support team, including families, carers and supporters.

The online portal should give consumers access to their mental health information (including
medications, discharge information, contacts and clinical notes, where appropriate). The
portal should draw information from the Mental Health Information and Data Exchange and
the Electronic Mental Health and Wellbeing Record, and put it into a user‑friendly format that
consumers can easily engage with. It should provide a consumer‑friendly viewing window
that makes it easy for consumers to find relevant information about their mental health
and wellbeing.

The Victorian Government should ensure the portal is accessible, inclusive and supports
multiple languages. It should be co‑designed with consumers to ensure it meets their needs
and preferences.

A number of health services are already moving to introduce consumer portals, and their
design could help inform the new approach. The portal should be available to both current
consumers and consumers who have been discharged from mental health and wellbeing
services, ensuring they can easily access their history and information as required.

For children, parents and guardians should have access to the portal in line with relevant best
practice, legislation and the consent approach. Consumers should also be able to authorise
sharing their portal access with families, carers and supporters if they wish.

The Commission notes that, in limited circumstances, it may not be safe or appropriate for
service providers to automatically provide consumers with access to their information (for
example, in times of severe distress).183 In such circumstances, the release of this information
could be delayed until the consumer is ready to receive this information, and the service
provider should ensure they discuss the information with the consumer before releasing it.184

The portal should not be used to communicate information to a consumer that they are not
already aware of through discussions with their service provider, such as a medication change.

Mental health and wellbeing service providers should also continue to ensure they can offer
user‑friendly non‑digital versions of records if requested, noting that some consumers may
choose not to receive their information in a digital format. Use of the portal should be optional.

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35.6.6  An inclusive implementation

approach with strong oversight
Strong oversight of the new ICT projects will be required to ensure effective development
and implementation, and to ensure continuing maintenance and upgrades. The following
principles should guide the management approach:

• The roles and authorities should be clearly defined, including decisions about
system design, responsibility for commissioning/contracting and implementation of
the system.
• The authority on specifications, selection and configuration should lie with those who
will benefit most from the system—those with lived experience and mental health
professionals (‘the users’).
• Entities should consult with people with expertise and knowledge, and not rely only on
staff tasked with implementing the system.
• ICT experts will need to advise on what is technically possible and implement the
decisions made by users.
• Leadership of the program should be embedded in the mental health and wellbeing
service delivery system, in collaboration with ICT experts.

The Commission advises the Victorian Government to establish a Mental Health Information
Sharing Program Board (within the Department of Health) with overall responsibility for the
program, including specifying the system requirements and setting priorities for investment.

The board would comprise those with lived experience of mental illness or psychological
distress, frontline mental health professionals who will use the system, families, carers
and supporters, experts who have successfully implemented health ICT systems, and the
department. For accountability purposes, the board should be chaired by an independent
person outside the public service.

A small commissioning, configuration and contract management unit—a program office—

should also be established within the department. The program office would ensure the
specifications and configuration of the new ICT systems are consistent with user needs and
reflected in the board’s decisions. It would create processes for consulting and engaging
frontline staff and those with lived experience. It would also support the work of the board.
The program office would be responsible for day‑to‑day management of the program
budget, based on the board’s investment priority decisions. The program office should
comprise people with frontline mental health experience and health informatics expertise.

Implementation of the proposed systems could be contracted out or delivered in house by the
department, depending on capability and cost. The board should decide who is to implement
the system based on advice from the program office.

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35.6.7  Implementation considerations

for new technology systems
The Department of Health should establish the proposed Mental Health Information Sharing
Program Board and program office to undertake a detailed upfront exploration of service
provider and consumer needs. This will inform the design of the new ICT systems, including
information to be collected, the new data items needed, and the systems’ functions and
operations.

The project should be guided by mental health and wellbeing workers and consumers, and
approached from a content and user perspective. It should not be led primarily from an ICT
point of view. This will ensure it is built to benefit those who will use it the most, and that the
systems are fit for purpose and sustainable.

As noted above, secure messaging should be quickly introduced to allow for appropriate
referrals to be electronically sent to Local Mental Health and Wellbeing Services and Area
Mental Health and Wellbeing Services, and for sharing of information between these services
and primary and secondary services. Ambulance Victoria should also be given access to
relevant information.

A minimum viable version of the new Electronic Mental Health and Wellbeing Record should
be established and rolled out in a staged way across Local Mental Health and Wellbeing
Services and Area Mental Health and Wellbeing Services and statewide services. This will
allow for iterative change and improvement in response to early testing and implementation.

The new Mental Health Information and Data Exchange should be established and trialled
with primary and secondary providers, emergency responders and Local Mental Health
and Wellbeing Services and Area Mental Health and Wellbeing Services, and with a selected
Regional Mental Health and Wellbeing Board. Findings from the trial should be used to refine
the arrangements and functions of the Mental Health Data and Information Exchange and
support its statewide rollout. The consumer portal should be trialled at the same time.

The ICT systems need to be developed in conjunction with the rollout of the broader reforms
recommended by the Commission. Careful initial planning and implementation will be
critical to ensure cost‑effectiveness and good outcomes. This will also ensure the systems
are designed appropriately for the new provider landscape in a responsive and integrated
mental health and wellbeing system.

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1 Witness Statement of Professor Ian Hickie AM, 11 August 2020, para. 118.
2 Sarah Kipping and others, ‘A Web-Based Patient Portal for Mental Health Care: Benefits Evaluation’, Journal of
Medical Internet Research, 18.11 (2016), 1–9 (p. 2); Deede Gammon and others, ‘Shifting Practices Toward Recovery-
Oriented Care Through an E-Recovery Portal in Community Mental Health Care: A Mixed-Methods Exploratory
Study’, Journal of Medical Internet Research, 19.5 (2017), 1–15 (p. 2).
3 Witness Statement of Kym Peake, 4 October 2020, para. 313; Witness Statement of Terry Symonds, 2 November
2020, paras. 313–314; Queensland Health, Information Sharing Between Mental Health Staff, Consumers, Family,
Carers, Nominated Support Persons and Others, 2018, p. 1.
4 Victorian Government, Submission to the RCVMHS: SUB.5000.0001.0001, 2019, p. 34.
5 National Mental Health Commissioner, Vision 2030: Blueprint for Mental Health and Suicide Prevention, 2020, p. 21;
Productivity Commission, Draft Report on Mental Health: Overview and Recommendations, 2019, p. 47.
6 Witness Statement of Shane Solomon, 22 May 2020, para. 22.
7 Under the Health Records Act 2001 (Vic), section 3, a person’s identity must be apparent or be reasonably able to
be ascertained from the information to be health information.
8 Health Records Act 2001 (Vic), sec. 3.
9 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings, 2020;
Australian Medical Association, Victoria, Submission to the RCVMHS: SUB.4000.0001.0008, 2019, pp. 103–104;
Lifeline Australia, Submission to the RCVMHS: SUB.0002.0029.0151, 2019, p. 32; Queensland Health, Information
Sharing Between Mental Health Staff, Consumers, Family, Carers, Nominated Support Persons and Others, p. 1.
10 Witness Statement of Dave Peters, 22 July 2020, paras. 41–42.
11 Witness Statement of Kym Peake, 2020, para. 315.
12 Health.vic, Disclosure of Health Information, <www2.health.vic.gov.au/mental-health/practice-and-service-quality/
mental-health-act-2014-handbook/oversight-and-service-improvement/disclosure-of-health-information>,
[accessed 5 November 2020].
13 Witness Statement of Terry Symonds, paras. 303–309; Witness Statement of Shane Solomon, paras. 72–78.
14 Witness Statement of Karyn Cook, 21 May 2020, para. 202.
15 Witness Statement of Shane Solomon, paras. 19–21.
16 Witness Statement of Terry Symonds, para. 313.
17 Royal Commission into Victoria’s Mental Health System, Interim Report, 2019, p. 171.
18 Royal Commission into Victoria’s Mental Health System, Interim Report, 2019, p. 115.
19 Royal Commission into Victoria’s Mental Health System, Interim Report, 2019, p. 115.
20 Joint Witness Statement of ‘Mary Corbett’ and ‘Jacob Corbett’ (pseudonyms), 25 June 2020, para. 105.
21 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
22 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
23 RCVMHS, Metro AMHS Provider Information Sharing Roundtable: Record of Proceedings, 2020.
24 Witness Statement of Shane Solomon, paras. 23 and 39.
25 Witness Statement of Shane Solomon, paras. 22–23.
26 Anonymous 49, Submission to the RCVMHS: SUB.0002.0028.0627, 2019, p. 2.
27 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
28 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings; Witness
Statement of ‘Rachel Bateman’ (pseudonym), 16 June 2020, paras. 149–150.
29 Victoria Legal Aid, Your Story, Your Say, 2020, p. 8.
30 Victorian Government, Submission in Response to the Draft Report from the Productivity Commission Inquiry into
Mental Health, 2020, p. 6.
31 RCVMHS, Carer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings, 2020.
32 RCVMHS, Carer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
33 RCVMHS, Carer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
34 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 262.
35 Productivity Commission, Mental Health Inquiry Report, Volume 2, 2020, p. 675.
36 Royal Commission into Family Violence, Report and Recommendations, Volume VI, 2016, p. 142.
37 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
38 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
39 Wei Wen Chong, Parisa Aslani and Timothy F. Chen, ‘Shared Decision-Making and Interprofessional Collaboration
in Mental Healthcare: A Qualitative Study Exploring Perceptions of Barriers and Facilitators’, Journal of
Interprofessional Care, 27.5 (2013), 373–379 (p. 376); Timothy C. Kariotis and Keith M. Harris, ‘Clinician Perceptions

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of My Health Record in Mental Health Care: Medication Management and Sharing Mental Health Information’,
Australian Journal of Primary Health, 25.1 (2019), 66–71 (pp. 68–69).
40 Gillian Strudwick, Anthony Yeung and David Gratzer, ‘Easy Access, Difficult Consequences? Providing Psychiatric
Patients With Access to Their Health Records Electronically’, Frontiers in Psychiatry, 10:917 (2019), 1–2 (p. 1).
41 Witness Statement of Dr Stuart Lewena, 11 May 2020, para. 69.
42 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
43 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
44 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
45 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
46 Freedom of Information Act 1982 (Vic), sec. 33(4).
47 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
48 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
49 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
50 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
51 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
52 Australian Psychological Society, APS Code of Ethics, 2007, pp. 14 and 19; Medical Board, Australian Health
Practitioner Regulation Agency, Good Medical Practice: A Code of Conduct for Doctors in Australia, 2020,
pp. 6 and 21.
53 Witness Statement of ‘Rachel Bateman’ (pseudonym), paras. 150–151.
54 Witness Statement of ‘Rachel Bateman’ (pseudonym), paras. 150–151.
55 Victoria Legal Aid, p. 8.
56 National Mental Health Consumer and Carer Forum, Privacy, Confidentiality and Information Sharing—
Consumers, Carers and Clinicians: A Position Statement and Issues Paper by the National Mental Health
Consumer and Carer Forum (NMHCCF), 2011, p. 7; L. S. Wilson and others, ‘Mental Health Professionals and
Information Sharing: Carer Perspectives’, Irish Journal of Medical Science, 184.4 (2015), 781–790 (p. 782).
57 RCVMHS, Carer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings; Wilson and
others, pp. 781–782.
58 Health Records Act 2001 (Vic), sec. 25.
59 Department of Health and Human Services, Making a Freedom of Information Request, <www.dhhs.vic.gov.
au/making-freedom-information-request>, [accessed 12 November 2020]; RCVMHS, Consumer Human-
Centred Design Focus Group—Information Sharing: Record of Proceedings; Office of the Victorian Information
Commissioner, Make a Freedom of Information Request, <ovic.vic.gov.au/freedom-of-information/for-the-public/
make-a-freedom-of-information-request/>, [accessed 22 December 2020].
60 Health Records Act 2001 (Vic), sec. 26.
61 Health Records Act 2001 (Vic), sec. 27.
62 Kipping and others, p. 2; Gammon and others, p. 2.
63 Witness Statement of Professor George Braitberg AM, 19 May 2020, para. 23.
64 Health Records Act 2001 (Vic), sec. 2.4; Mental Health Act 2014 (Vic), sec. 346(2)(h); Mental Health Act 2014 (Vic), sec.
346(2)(g).
65 A designated mental health service is a service defined as being able to deliver mental health services under the
Mental Health Act 2014 (Vic). There are a limited number of designated mental health services in Victoria.
66 Mental Health Act 2014 (Vic), sec. 346(2).
67 Department of Health and Human Services, New Laws to Improve Quality and Safety in the Health System:
Frequently Asked Questions—For Patients, 2020, p. 2.
68 Witness Statement of Simon Thomson, 24 June 2019, para. 51.4.
69 Witness Statement of Simon Thomson, paras. 51.4 and 88.1.
70 Witness Statement of Simon Thomson, para. 59.1.
71 RCVMHS, Metro AMHS Provider Information Sharing Roundtable: Record of Proceedings.
72 RCVMHS, Metro AMHS Provider Information Sharing Roundtable: Record of Proceedings.
73 Witness Statement of Dave Peters, paras. 47 and 48.
74 Human Services (Complex Needs) Act 2009 (Vic), secs. 1, 14 and 17.
75 Coroner Simon McGregor, Coronial Inquest into the Death of Darren Brandon (Melbourne, 2020), pp. 56–57.
76 Witness Statement of Associate Professor Ruth Vine, 29 April 2020, para. 151.
77 Witness Statement of Dr Shaymaa Elkadi, 25 May 2020, para. 128.

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78 Family Violence Protection Amendment (Information Sharing) Act 2017 (Vic), sec. 7; Victorian Auditor-General’s
Office, Implementation of the Criminal Justice Enhancement Program (CJEP), 2008, pp. 11–14 and 65–69; Family
Safety Victoria, Family Violence Information Sharing Guidelines, 2018, pp. 18–34.
79 Witness Statement of Julie Edwards, 21 May 2020, para. 12.
80 Witness Statement of Julie Edwards, para. 66.
81 Mental Health Act 2014 (Vic), sec. 347.
82 Witness Statement of Terry Symonds, para. 298.
83 Monash Health, Submission to the RCVMHS: SUB.7000.0003.0001, 2019, p. 78; Witness Statement of Dr Elizabeth
Deveny, 8 June 2020, paras. 98–100; Witness Statement of Dr Stuart Lewena, para. 68; Witness Statement of Dr
Shaymaa Elkadi, para. 128.
84 Witness Statement of Terry Symonds, para. 304.
85 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
86 Queensland Health, Integrated Electronic Medical Record (IeMR), <www.health.qld.gov.au/clinical-practice/
innovation/digital-health-initiatives/queensland/integrated-electronic-medical-record-iemr>, [accessed 10
December 2020]; eHealth New South Wales, EMR Connect, <www.ehealth.nsw.gov.au/programs/clinical/emr-
connect>, [accessed 10 December 2020]; South Australia Health, Sunrise EMR and PAS, SA Health’s Electronic
Medical Record, <www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/
clinical+information+systems/sunrise+emr+pas/sunrise+emr+pas+sa+healths+electronic+medical+record>,
[accessed 10 December 2020].
87 RCVMHS, Meeting with Department of Health and Human Services Meeting Notes, 22 June 2020, p. 3.
88 Productivity Commission, Mental Health Inquiry Report, Volume 2, p. 676.
89 Australian Digital Health Agency, My Health Record, <www.myhealthrecord.gov.au/>, [accessed 13 August 2020].
90 Australian Digital Health Agency, National Health Interoperability Principles, 2020, pp. 6 and 15–16.
91 CSIRO, Future of Health: Shifting Australia’s Focus from Illness Treatment to Health and Wellbeing Management,
2018, p. 34; Australian Digital Health Agency, National Health Interoperability Principles, p. 34.
92 Australian Digital Health Agency, National Health Interoperability Principles, p. 8.
93 Australian Digital Health Agency, National Health Interoperability Principles, p. 6.
94 Ontario Health ICT System, Health Report Manager Supports Virtual Care and the Integration of
Patient Information in Ontario Health Teams, 5 February 2020, <www.globenewswire.com/news-
release/2020/02/05/1980410/0/en/Health-Report-Manager-supports-virtual-care-and-the-integration-of-patient-
information-in-Ontario-Health-Teams.html>, [accessed 5 November 2020].
95 Ontario Health ICT System, Health Report Manager Supports Virtual Care and the Integration of
Patient Information in Ontario Health Teams, 5 February 2020, <www.globenewswire.com/news-
release/2020/02/05/1980410/0/en/Health-Report-Manager-supports-virtual-care-and-the-integration-of-patient-
information-in-Ontario-Health-Teams.html>, [accessed 5 November 2020].
96 Precedence Health Care, How Inca Works, <precedencehealthcare.com/inca/>, [accessed 17 December 2020].
97 Department of Health and Human Services, Digitising Health: How Information and Communications Technology
Will Enable Person-Centred Health and Wellbeing Within Victoria, 2016, pp. v and 4.
98 RCVMHS, Meeting with Department of Health and Human Services Meeting Notes, p. 2.
99 RCVMHS, Metro AMHS Provider Information Sharing Roundtable: Record of Proceedings; RCVMHS, Regional
AMHS Provider Information Sharing Roundtable: Record of Proceedings, 2020; Witness Statement of Shane
Solomon, para. 33.
100 Witness Statement of Terry Symonds, para. 307.
101 RCVMHS, Meeting with Department of Health and Human Services Meeting Notes, p. 2.
102 Witness Statement of Shane Solomon, paras. 33–34.
103 RCVMHS, Regional AMHS Provider Information Sharing Roundtable: Record of Proceedings; Witness Statement of
Shane Solomon, para. 35.
104 RCVMHS, Metro AMHS Provider Information Sharing Roundtable: Record of Proceedings.
105 RCVMHS, Metro AMHS Provider Information Sharing Roundtable: Record of Proceedings; RCVMHS, Regional AMHS
Provider Information Sharing Roundtable: Record of Proceedings.
106 Royal Australian College of General Practitioners, RACGP Practice Technology and Management: Minimum
Requirements for General Practice Clinical Information Systems to Improve Usability, 2019, p. 1.
107 Witness Statement of Shane Solomon, para. 47.
108 Witness Statement of Professor George Braitberg AM, para. 22.
109 Witness Statement of Professor George Braitberg AM, para. 22.
110 Witness Statement of Terry Symonds, para. 305.

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111 RCVMHS Meeting with DHHS and VAHI Meeting Notes, 6 July 2020, p. 3.
112 health.vic, Client Management Interface/Operational Data Store Service Contacts, <www2.health.vic.gov.au/
mental-health/research-and-reporting/reporting-requirements-for-clinical-mental-health-services/service-
contacts>, [accessed 15 May 2020]; Witness Statement of Shane Solomon, para. 36; Witness Statement of Terry
Symonds, paras. 303–311.
113 RCVMHS Meeting with DHHS and VAHI Meeting Notes, p. 8.
114 RCVMHS Meeting with DHHS and VAHI Meeting Notes, p. 8.
115 RCVMHS Meeting with DHHS and VAHI Meeting Notes, p. 3.
116 RCVMHS Meeting with DHHS and VAHI Meeting Notes, p. 3.
117 RCVMHS Meeting with DHHS and VAHI Meeting Notes, p. 6; Witness Statement of Dr Neil Coventry, 29 July
2020, para. 92.
118 RCVMHS, Metro AMHS Provider Information Sharing Roundtable: Record of Proceedings; RCVMHS Meeting with
DHHS and VAHI Meeting Notes, p. 5.
119 Bendigo Health, Submission to the RCVMHS: SUB.0002.0030.0051, 2019, pp. 21–22; RCVMHS, Regional AMHS Provider
Information Sharing Roundtable: Record of Proceedings; Witness Statement of Shane Solomon, para. 36.
120 Victorian Auditor-General’s Office, Access to Mental Health Services, 2019, p. 46; RCVMHS, Metro AMHS Provider
Information Sharing Roundtable: Record of Proceedings.
121 Victorian Auditor-General’s Office, Access to Mental Health Services, p. 46; RCVMHS, Metro AMHS Provider
Information Sharing Roundtable: Record of Proceedings.
122 RCVMHS, Metro AMHS Provider Information Sharing Roundtable: Record of Proceedings; RCVMHS, Regional AMHS
Provider Information Sharing Roundtable: Record of Proceedings.
123 Witness Statement of Professor Robert Thomas OAM, 12 May 2020, para. 75.
124 Witness Statement of Dr Stuart Lewena, paras. 67–68.
125 NorthWestern Mental Health (A Division of Melbourne Health), Submission to the RCVMHS: SUB.0002.0030.0061,
2019, p. 29.
126 Monash Health, p. 78.
127 RCVMHS, Metro AMHS Provider Information Sharing Roundtable: Record of Proceedings; RCVMHS, Regional AMHS
Provider Information Sharing Roundtable: Record of Proceedings.
128 RCVMHS, Regional AMHS Provider Information Sharing Roundtable: Record of Proceedings.
129 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
130 RCVMHS, Metro AMHS Provider Information Sharing Roundtable: Record of Proceedings; RCVMHS Meeting with
DHHS and VAHI Meeting Notes, p. 4.
131 Mental Health Australia, Submission in Response to the Draft Report from the Productivity Commission Inquiry
into Mental Health, 2020, p. 32; Productivity Commission, Draft Report on Mental Health, Volume 1, 2019, p. 66;
Witness Statement of Scientia Professor Helen Christensen AO, 18 July 2019, para. 52; Mental Health Legal Centre,
Submission in Response to the Draft Report from the Productivity Commission Inquiry into Mental Health,
2020, p. 5; Allied Health Professions Australia, Submission in Response to the Draft Report from the Productivity
Commission Inquiry into Mental Health, 2020, p. 3.
132 Bendigo Health, p. 21.
133 RCVMHS, Metro AMHS Provider Information Sharing Roundtable: Record of Proceedings; RCVMHS, Regional AMHS
Provider Information Sharing Roundtable: Record of Proceedings.
134 RCVMHS, Primary Health Networks Roundtable: Record of Proceedings, 2020.
135 RCVMHS, Primary Health Networks Roundtable: Record of Proceedings.
136 Witness Statement of Dr Elizabeth Deveny, para. 100.
137 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
138 The Adult Psychiatry Imperative, Submission to the RCVMHS: SUB.3000.0001.0070, 2019, p. 68.
139 Witness Statement of Terry Symonds, para. 182.
140 Witness Statement of Terry Symonds, para. 183.
141 Witness Statement of Shane Solomon, para. 19.
142 Witness Statement of Shane Solomon, paras. 76–78.
143 RCVMHS, Metro AMHS Provider Information Sharing Roundtable: Record of Proceedings.
144 Witness Statement of Terry Symonds, para. 185.
145 Victorian Auditor-General’s Office, Access to Mental Health Services, p. 12.
146 Witness Statement of Shane Solomon, para. 73.

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147 Witness Statement of Dr Lynne Coulson Barr OAM, 4 June 2020, para. 89; Witness Statement of Louise Glanville, 8
July 2019, paras. 68–73.
148 RCVMHS, Culturally and Linguistically Diverse People Roundtable: Record of Proceedings, 2019.
149 Witness Statement of Terry Symonds, para. 185.
150 Witness Statement of Karyn Cook, para. 202(a).
151 Witness Statement of Shane Solomon, para. 19.
152 Witness Statement of Shane Solomon, para. 20.
153 Witness Statement of Shane Solomon, para. 20.
154 Witness Statement of Terry Symonds, para. 187.
155 Victorian Government, Submission to the RCVMHS: SUB.5000.0001.0001, p. 34.
156 Victorian Government, Submission to the RCVMHS: SUB.5000.0001.0001, p. 34.
157 Witness Statement of Shane Solomon, para. 21.
158 Witness Statement of Professor Suresh Sundram, 19 May 2020, para. 115.
159 Public Health and Preventive Medicine, Monash University, What Are Clinical Registries?, <www.monash.edu/
medicine/sphpm/registries/what-are-clinical-registries>, [accessed 5 November 2020].
160 Witness Statement of Professor Suresh Sundram, para. 116.
161 Witness Statement of Professor Suresh Sundram, paras. 115–116.
162 Witness Statement of Professor Suresh Sundram, paras. 115–116.
163 The Adult Psychiatry Imperative, p. 68.
164 Latrobe Regional Hospital, Submission to the RCVMHS: SUB.0002.0028.0034, 2019, pp. 5–6.
165 Witness Statement of Terry Symonds, para. 317(a).
166 Office of the Victorian Information Commissioner, What We Do, <ovic.vic.gov.au/about-us/what-we-do/>, [accessed
18 December 2020].
167 Office of the Victorian Information Commissioner, What We Do; PricewaterhouseCoopers, Review of Information
Governance in the Department of Health and Human Services (DHHS), 2017.
168 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.
169 Witness Statement of Terry Symonds, para. 314; The Adult Psychiatry Imperative, pp. 70–71.
170 St Vincent’s Hospital Melbourne, Submission to the RCVMHS: SUB.0002.0030.0106, 2019, p. 28.
171 CSIRO, p. 32.
172 CSIRO, p. 32.
173 Productivity Commission, Mental Health Inquiry Report, Volume 2, p. 678.
174 Productivity Commission, Mental Health Inquiry Report, Volume 2, p. 678.
175 Peninsula Health, Submission to the RCVMHS: SUB.0002.0028.0109, 2019, p. 7.
176 Witness Statement of Terry Symonds, para. 303.
177 Witness Statement of Terry Symonds, para. 308.
178 Witness Statement of Dave Peters, para. 44.
179 Witness Statement of Dave Peters, para. 44.
180 Witness Statement of Kym Peake, 2020, para. 315.
181 Witness Statement of Kym Peake, 2020, para. 317.
182 Ambulance Victoria, COVID 19 Enhanced Mental Health Triage Response Pilot Proposal, 2020.
183 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings; Witness
Statement of Emeritus Professor Terry Carney AO, 17 July 2020, para. 73.
184 RCVMHS, Consumer Human-Centred Design Focus Group—Information Sharing: Record of Proceedings.

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Chapter 36

Research, innovation
and system learning

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Recommendation 63:

Facilitating translational
research and its dissemination
The Royal Commission recommends that the Victorian Government:

1. building on the interim report’s recommendation 1, by the end of 2023, enable the
Collaborative Centre for Mental Health and Wellbeing, to:

a. f acilitate translational research throughout the mental health and wellbeing system,
including in collaboration with other research centres and institutes;
b. e
nsure new research aligns with initial reform priorities identified by the Royal
Commission;
c. s
trengthen and support a formal network of academic service leaders responsible
for sharing and applying research in service settings;
d. e
nsure that evidence informs workforce education and training, and promotes
cultures of inquiry, innovation and learning;
e. p
rovide a ‘clearing house’ to collect, combine and share information from research,
innovation projects and evaluations; and
f. p
rovide authoritative advice on evidence-informed approaches to treatment, care
and support to inform policy development, planning and investment.

2. i dentify and promote opportunities to increase collaboration in translational research

on the mental health and wellbeing of infants, children and young people.

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Recommendation 64:

Driving innovation in mental health

treatment, care and support
The Royal Commission recommends that the Victorian Government:

1. c
ommission an existing entity to provide dedicated support and resources for
innovation in mental health treatment, care and support.
2. fund this entity to:

a. a
dminister a dedicated mental health innovation fund for projects selected by
an expert panel;
b. e
stablish and promote collaborative networks to drive and facilitate innovation
in mental health treatment, care and support; and
c. p
rovide practical support to services to implement and test new approaches
to mental health treatment, care and support.

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Recommendation 65:

Evaluating mental health

and wellbeing programs,
initiatives and innovations
The Royal Commission recommends that the Victorian Government:

1. s
et an expectation that adequate evaluation is a condition of funding for all new
mental health and wellbeing programs, initiatives and innovations.
2. develop and fund a strategy to ensure evaluation routinely informs the implementation
of reforms and ongoing decision making about policies and investment.
3. p
romote and improve evaluation practices throughout the mental health and wellbeing
system by issuing guidance and facilitating access to evaluation expertise.

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36.1  Why an adaptive system is needed

The Commission’s recommendations call for considerable changes to all aspects of Victoria’s
mental health system. The Commission stated in its interim report that the new reforms must
represent the beginning of a contemporary system that adapts and responds to the needs of
Victorians.1

As Dr Ravi Bhat, Divisional Clinical Director at Goulburn Valley Area Mental Health Service,
Goulburn Valley Health, explained, the system needs to be flexible enough to respond to new
developments:

we can easily fall into the trap of thinking that we have all the answers. I think we should
not. I think that the future is inherently uncertain. It’s not like a roulette machine where
the odds are known and we can predict what’s going to happen, it’s inherently uncertain.
So, I think that we should be careful about saying things like lasting changes and so on.
I think that we should design a system for the realities that we know today, but I think
that we should develop a system that is reflective, that is adaptive, that is responsive,
that is data‑informed.2

A system must adapt in a changing context. An adaptive system is one that can identify and
test new ideas, gather evidence about what works, and translate this into effective treatment,
care and support. In an adaptive system, evidence about what works is used to continually
improve professional practice, service design and system policy. The knowledge, expertise
and experience of consumers, carers and people who work in the system are integral to
effective change and improvement.

To meet a gap in translational research into treatment, care and support for adults, the
Commission boosted the foundations for an adaptive mental health and wellbeing system, by
recommending the establishment of the Victorian Collaborative Centre for Mental Health and
Wellbeing in its interim report (refer to Box 36.1). The collaborative centre will bring together
clinical, academic and peer researchers with a range of disciplinary expertise, and will be
pivotal in growing the research base and supporting the translation of research evidence
into practice.

The Commission’s vision is for a modern and sustainable system that responds to Victorians’
needs into the future. It must be designed with components that allow the system to be reflective
and evolving. It must also create conditions where improvement and innovation can flourish.

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Box 36.1:  The Victorian Collaborative Centre

for Mental Health and Wellbeing

The Commission’s interim report recommended that the Victorian Government

establish a new entity, the Victorian Collaborative Centre for Mental Health and
Wellbeing.3 The Commission’s vision is that the collaborative centre will deliver a
long‑identified need for the Victorian mental health system.

The interim report envisaged that the collaborative centre will:

• lead exemplary practice for the full and effective participation and
inclusion of people with lived experience across the mental health system
• lead interdisciplinary, translational research into new treatments and
models of care and support, to inform service delivery, policy and
law making
• educate the mental health workforce through practice improvement,
training and professional development programs.

The collaborative centre will conduct interdisciplinary research alongside

service delivery for adults, reinforcing the translation of research and evidence
into high‑quality care through Regional Mental Health and Wellbeing Boards,
including in rural and regional areas. It will also run a Statewide Trauma Service
providing direct service delivery to adults, and working in partnership with
services for infants, children and young people.

The purpose‑built collaborative centre will provide comprehensive services to

adults in its local community, including community‑based and home-based
treatment, services provided in outpatient clinics and other non‑hospital settings,
crisis responses and inpatient care (subacute and acute). Non‑clinical services
will include programs that involve: a consumer’s network and their choice of
friends and family; wellbeing supports; and creative and supportive group
therapy. In line with the recommendations made in Chapter 5: A responsive and
integrated system, services will also integrate physical health care and support
for substance use or addiction, to meet the holistic needs of people living with
mental illness.

These local services will be complemented by specialist (including statewide)

services that focus on treatment, care and support for people living with mental
illness needing ongoing intensive treatment, care and support.

The interim report stated that the collaborative centre will embody the
characteristics of responsiveness, collaboration and continuous improvement
that exemplify the future system. Critically, it will emphasise the participation
of people with lived experience in the design, development and production of
research programs.

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The Productivity Commission highlighted the collaborative centre as an example

of an innovative and networked approach to enable research translation and
knowledge dissemination.4 It called for ‘national research infrastructure and
networks that enable coordinated and collaborative research to … help achieve
translation and dissemination of research evidence’, to enable stronger alignment
of research to national priorities.5 It reported that the National Health and
Medical Research Council has announced funding to establish a national centre
in mental healthcare that will support a collaborative network.6 As a forerunner,
the collaborative centre and its future partners will be able to provide leadership
and offer a strong contribution to national research efforts.

36.1.1  Forces shaping the mental health and wellbeing system

The social, cultural, economic and physical environments in which we live influence our
mental health and wellbeing. As a society, we are facing major trends and challenges from
declining social connection and support;7 population changes that are increasing disparities
in people’s quality of life;8 and growing economic inequalities, particularly for people living
in rural and regional locations.9 As disadvantage and inequity grow, disparities in access to
healthcare and health outcomes also grow.

Despite past reforms, however, the mental health system has failed to keep up with the
changing needs and expectations of the people for whom it exists.10 It is the Commission’s
view that the system must be designed to tackle inequity head on, and it must be able to
respond and adapt as the issues driving inequity evolve. This means ensuring that the best
aspects of the system are widely accessible across the state, by speeding up the diffusion of
leading practices and approaches.

Victoria also needs a system that is resilient and adaptable in the face of unpredictability.
Unexpected events, such as the 2019–20 summer bushfires and the COVID‑19 pandemic, have
had considerable effects on the health and wellbeing of Victoria’s population, and on the
ways that treatment, care and support are provided.

The Commission has heard many accounts of rapid innovation in response to these events.
These include the use of telehealth, digital improvements to youth mental health services,
and collaborative governance arrangements.11 Solutions have drawn on expertise that is not
traditionally used in public system problem solving.12 Barriers that would usually take years
to remove have been swept aside, allowing solutions to be implemented quickly.13 Mr Angus
Clelland, CEO of Mental Health Victoria, noted that ‘even with tight resources, we are seeing
changes occur rapidly in response to COVID‑19’.14

While tragic, the effects of COVID‑19 have created a new spirit of cooperation. Continuing
this collaborative approach beyond the pandemic will be important to the mental health and
wellbeing system’s future success.15

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36.1.2  Continued capacity to respond, learn and improve

The ability to continually respond and improve is vital to the success of the future mental
health and wellbeing system. Unexpected challenges and events will continue to arise.

The Commission believes that the system will be better equipped if it can use the momentum
generated by the challenges faced in 2020 to solve collective problems in the future. It has
considered how governments and systems around the world are finding better ways to solve
problems, respond to challenges and develop sustainable systems that continually improve.
In response to these considerations, the Commission has adopted a systems‑change mindset
to the mental health system. This approach, explained in more detail in Chapter 2: The
Commission’s approach to reform, is suited to dealing with complex and shared problems. It
brings together a wide range of interested parties with diverse skills and expertise, who work
to fully understand a problem, identify innovative solutions and speed up the change needed
to achieve them.16

Governments, locally and globally, are actively engaging innovation and entrepreneurship in
public service priorities. Examples within Victoria include:

• LaunchVic, a government agency established to develop Victoria’s start‑up

environment, to grow and deliver economic and cultural benefits for the state17
• the Better Care Victoria Innovation Fund, which supports sector‑led innovation and
improvement projects in the Victorian health sector18
• social impact bonds19 and Partnerships Addressing Disadvantage, which encourage
innovative collaboration and investment strategies between public, private and
not‑for‑profit sectors, to reduce social disadvantage 20
• the Victorian Government’s 2020–21 budget provision for a $2 billion Breakthrough
Victoria Fund to drive investment in translational research and innovation in industries
including health and life sciences, and digital technologies.21

As described in the Commission’s interim report, decades of past reforms have failed to
deliver a mental health system that can meet consumer needs, keep up with demand, or
deliver contemporary approaches to treatment, care and support. There is the potential now
to make ‘exponential progress’ supported by technology and innovation, but this requires a
change in culture to adopt new approaches and innovation.22

Research, practice development, innovation and evaluation are critical parts of an adaptive
system. To ensure continuous improvement, mechanisms must be put in place to ensure
evidence reaches the people who design and deliver services, and new ideas and innovative
approaches must be rapidly and consistently applied to policy and practice.

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36.2  Building an adaptive

mental health and wellbeing
system for Victoria
Transforming Victoria’s mental health system is an inherently complex process. The sheer
scale and diversity of the system’s components are considerable. However, complex systems
can be transformed. The adaptive and dynamic nature of systems means that transformation
is not achieved by directing or controlling the system. Instead, it is achieved through
changing, influencing or encouraging the system to produce better outcomes.23 This requires:

• a willingness to deal with ambiguity, complexity and uncertainty, and to focus on

identifying ways to effect change
• creating intentional platforms for continuing dialogue between people with diverse
perspectives, expertise and experiences, to encourage new ways of thinking
• continued reflection to identify what works and promote a flexible and responsive
approach to uncertainty and complexity.

The new system design must include and connect core improvement activities through cycles
of learning as depicted in Figure 36.1. These include:

• research to establish a strong evidence base about effective models of care

• capacity for innovation to test and grow the evidence base with new ideas
• processes to capture new knowledge and ideas and translate them into practice
• capabilities to monitor and evaluate the effects of new and established approaches
• mechanisms to synthesise and share the information from all these sources, and use it
to make decisions and improvements across the system.

The Commission’s recommended approach (outlined in section 36.6) will support the
necessary activities and relationships to connect innovation and improvement activities in
cycles of learning. The Commission envisages that the Victorian mental health and wellbeing
system will have a range of leading centres contributing to this effort.

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Figure 36.1:  Cycles of learning incorporating research, innovation,

practice translation and sharing knowledge

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Box 36.2:  Key concepts

Research and knowledge translation

Mental health research refers to a wide spectrum of activities that include

investigating: causes of mental illness and psychological distress and how to
respond to these; potential treatments for mental illness; models of system design
and service delivery; and social science–based approaches to interventions
and services.

Translational research involves testing and applying new treatments and models
of care in service delivery environments. Knowledge translation refers to the
process of disseminating translational research or other new knowledge though
the system.

Innovation

• The term innovation is often loosely defined. In this chapter, it is used

broadly to mean experimentation and entrepreneurial activity that creates
value‑adding change by developing and testing new solutions.
• Innovation can be thought of as: a disruptive force that interrupts old
approaches or creates new value for consumers; or a sustaining activity
that improves and builds on what already exists, but maintains continuity.24
• Innovation can take place at the system, service or community level,
and can emerge from individuals or small groups within the system
finding better ways to undertake their day‑to‑day activities (grassroots
innovation).
• Collective impact is where different people work together to tackle
complex social issues in local communities. A collective impact framework
consists of five supporting conditions: a common agenda, continuous
communications, a shared measurement system, mutually reinforcing
activities, and a coordination function.25
• Start‑ups are companies or projects initiated by an entrepreneur to
seek, develop, test and validate a scalable business model and bring it to
market.26 Start‑up accelerators provide initial investment and intensive,
time‑limited business or partnership support to help get new ideas ready
for investment as rapidly as possible.

Practice translation

• Practice translation is the process of using knowledge about what works—

from research, innovation and locally developed approaches—to embed
new approaches into the routine activities of people working in the system.

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Evaluation

• Evaluation is the systematic process of collecting and analysing

information to enable assessment of an activity, project, policy or
program.27 The purpose is often to support knowledge translation, to grow
and expand effective approaches, or to inform future policy or investment
decisions.
• Formative or developmental evaluations determine whether a new initiative
is on track to achieve desired outcomes, and are used to make adaptations
during the implementation process. Summative or impact evaluations
assess what has been achieved, once implementation is complete.

Figure 36.2 outlines the Commission’s recommended functions and activities for a mental
health and wellbeing system that innovates, learns and adapts. It shows the activities that will
be performed by the collaborative centre and a range of potential partners. It also depicts
the relationships between those functions, mental health and wellbeing services, and the
Department of Health. The goal of the new arrangements is to use knowledge and expertise
in the most widespread and coordinated way possible, and allow promising and proven ideas
to flourish.28

These arrangements provide for:

• translational research to be undertaken by the collaborative centre and other partner

organisations working in a learning ‘network’, in which many parties contribute to, and
benefit from, improved data and knowledge sharing about what works
• Regional Mental Health and Wellbeing Boards, Area Mental Health and Wellbeing
Services, and Local Mental Health and Wellbeing Services to be formally connected to
translational research activities and receive support to enable local innovation and put
research into practice
• innovation capability that, across the entire mental health and wellbeing system:

– develops networks to bring together innovators and partners

– administers a fund to support innovation activity
– assists testing, monitoring and refinement of new approaches and innovations
– creates feedback loops from service-level activities to share learning from
implementation experiences, and promote promising innovations for evaluation and
potential scaling

• the Department of Health to receive information from research, innovation and

practice on the ground, to evaluate what works and inform decisions about policy
design, commissioning and investment.

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Figure 36.2:  An adaptive mental health and wellbeing system in Victoria

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36.3  An example of innovation

and system learning in action
The Commission looked globally and found many examples of innovation and system
learning in practice. Ontario Health Teams, created by the Government of Ontario in Canada,
were a major reform to make Ontario’s health system more responsive to local needs.29

The Ontario Health Teams model builds on local innovation to ‘transform the way health
care is provided and funded’. The model enables ‘patients, families, communities, providers,
and system leaders to better work together, innovate and build on what is best in Ontario’s
healthcare system. The goal is to provide better, more connected care across the province’.30
This partnership approach is also discussed in Chapter 29: Encouraging partnerships.

These self‑organising, locality‑based teams are supported by a government‑funded Rapid

Improvement Support and Exchange (RISE) function to enable learning and improvement
(refer to case study).

RISE aims to create a rapidly learning health system that achieves ‘the quadruple aims of
improving care experiences and health outcomes at manageable per capita costs and with
positive provider experiences’.31 Through RISE, Ontario Health Teams receive consistent and
equitable access to help and guidance when implementing new approaches. This allows
questions, suggestions and improvements to be discussed and implemented quickly and
effectively, helping Ontario Health Teams to generate improvement at the point of care for
their local populations. Evidence of the successes and failures of local initiatives is collected
and shared with the RISE and Ontario Health Team communities of practice. Over time, this
will generate a self‑improving system that is able to adapt and respond to issues identified,
and create sustainable improvements.

The strength of this model is its focus on continuous improvement and knowledge exchange,
which grows consistency and resilience in the system.

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Case study:

Rapid Improvement
Support and Exchange
Ontario Health Teams are designed to make Ontario’s health system more responsive
to local needs. They are groups of health providers who partner to deliver integrated
healthcare services. The first teams were announced in December 2019. Once fully
operational, they will be jointly accountable for the cost and provision of services. They
will also share accountability for health outcomes and care experiences of their local
population, including for mental health and addiction.

Rapid Improvement Support and Exchange (RISE) is a collaborative platform supported

by a grant from the Ontario Ministry of Health, and is designed to help Ontario
Health Teams achieve their goals. As health teams develop, they need to learn and
improve quickly. RISE helps them do this by providing access to ‘rapid learning and
improvement assets’.

According to RISE, rapid learning and improvement involves six steps:

1. identifying a problem or goal

2. designing a solution based on data and evidence
3. implementing the plan (possibly in pilot and control settings)
4. evaluating to identify what does and does not work
5. adjusting, with continuous improvement based on what was learned from the
evaluation and from other health teams
6. disseminating the results to improve the coverage of effective solutions across
the health system.

RISE provides teams with three types of support: coaching, collaboratives and
communities of practice.

The more active forms of support—coaching and collaboratives—are targeted at

the most difficult part of the health system transformation, namely the shift from
a traditional, reactive model of care to a more practice‑based and coordinated
‘population‑health management’ approach to care.

Online communities of practice, which are less intensive, member‑driven supports,

focus on the other critical building blocks of the transformation (for example, patient
partnership and digital health). They provide an opportunity for teams to identify their
own learning needs, to share experiences of success and failure, and to build their
ability to become a sustainable, self‑improving system.

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RISE also delivers an ‘on demand’ suite of activities (for example, convening ‘jamborees’
to work through important challenges like how best to engage clinicians in teams)
and products (for example, briefs and analyses of evidence on priority topics like
collaborative governance).

RISE uses a number of approaches to share tools and resources with teams, including
a website, monthly newsletter, webinars and Twitter. It puts a lot of effort into ensuring
that all products use frameworks and language specific to and consistent with the
transformation project.

Professor Rob Reid, Chief Scientist of Trillium Health Partners and co‑lead of RISE, said
researchers are the backbone of RISE.

Researchers help teams to push through the stages of the learning cycle. This
starts with developing a deep understanding of the problem they are trying to
solve, and how it has been tackled elsewhere. Then we bring science into the
design of better models of care, making consumer experiences the focus, and
building in the new skills, resources and ways of working that will be needed to
implement them. Then we help them use the Ontario Health Teams evaluation
framework to assess what’s happening when they implement new models in the
field, and feed information back to them in a continuous loop so they can adjust
their approach.

RISE also partners with many health system partners to support research translation,
capability development and evidence building. These partners include the new Ontario
Centre of Excellence for Mental Health and Addictions as well as the Centre for Effective
Practice, an independent research and knowledge translation organisation focusing on
primary care.

Professor John Lavis, Director of the McMaster Health Forum and co‑lead of RISE, said
that government, health system partners, research partners and RISE staff are all
motivated to collaborate in improving mental health services for people in Ontario.

The outcomes that matter are mental health and care experiences—and you must
be able to measure and improve both. Mental health touches everyone. And we
can and must do better for people.

Sources: McMaster University, Rapid-Improvement Support and Exchange, <mcmasterforum.org/rise/

learn-about-rise/overview>, [accessed 6 October 2020]; RISE, RISE brief 12: Rapid learning and improvement,
<mcmasterforum.org/docs/default-source/rise-docs/rise-briefs/rb12_rapid-learning-improvement.
pdf?sfvrsn=a1bf54d5_14>, [accessed 15 December 2020]; RCVMHS, Interview with Professor John Lavis, 17 August
2020; RCVMHS, Interview with Professor John Lavis, 19 November 2020.; RCVMHS, Interview with Professor Rob
Reid, 10 December 2020.

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36.4  The features of an

adaptive mental health and
wellbeing system
In exploring how different systems are set up for continual learning and improvement,
the Commission has observed commonly identified components and features of
adaptive systems.

36.4.1  Cultures of inquiry, reflection and courage

Transformational leadership is needed to allow innovation to flourish. Organisations and
leaders need to create supportive environments for people to collaborate, develop new ideas,
take risks, work closely with consumers and test new models that inspire change.32

Associate Professor Simon Stafrace, Chief Adviser, Mental Health Reform Victoria, told the
Commission in his personal capacity that enabling systems and organisations to adapt and
innovate involves allowing for ‘multiple mindsets to operate in a complex environment’.33 Dr
Hila Haskelberg, Program Manager of THIS WAY UP at St Vincent’s Public Hospital Sydney,
providing evidence in her personal capacity, suggested that this requires relationships built
on trust, supported by technology and promoted by committed leaders.34

Getting the most out of collaborative innovation requires a cultural shift to support the
inclusion of multiple voices, flexibility in problem solving, and spaces and time for invention
and reflection. The National Health Service Institute for Innovation and Improvement in the
United Kingdom identifies cultural features that need to be encouraged for innovation (refer
to Figure 36.3).35

Associate Professor Jo‑An Atkinson, Managing Director, Computer Simulation and Advanced
Research Technologies; Head of Systems Modelling and Simulation with the Brain and Mind
Centre, University of Sydney, also advocated in a personal capacity for more innovation
in mental health. She suggests that structures and mechanisms governing mental health
research influence the extent to which research partnerships are created and sustained,
and innovation is supported. She also advised that a conservative culture in mental health
research persists ‘such that forays into alternative methods … are perceived as high risk and
exploratory’.36

Associate Professor Stafrace argues that the following conditions must be actively
encouraged to challenge the dominant culture within Victoria’s mental health system:

There must be investment in individual and organisational development … An element

of this process should embrace adaptive and transformational work that challenges
established assumptions about power, safety and change.37

The Commission’s view is that a more open and collaborative culture of reflection and
innovation in mental health is important to ensure Victorians will benefit from new ideas
and ways of working.

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Figure 36.3:  Cultural framework for innovation

Source: Adapted from NHS Institute for Innovation and Improvement, Creating the culture for innovation: A practical
guide for leaders, 2010.

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36.4.2  Place people with lived experience at the centre

Consumer‑led research and evaluation is fundamental to an adaptive system. Consumers
are needed to set new research agendas and help develop new theories and ways of
knowing.38 The collaborative centre presents a unique opportunity to place people with lived
experience at the centre of service design, delivery, research and evaluation.39

Lived experience experts advised the Commission that consumers need to lead research
and innovation. Ms Cath Roper, Consumer Academic at the Centre for Psychiatric Nursing,
University of Melbourne, said:

There are two things we can do to champion the co‑production of research and
innovation in mental health. First, we can open up leadership roles for consumers which
means … others will need to step back into support roles; and secondly, we can start
elevating consumer leaders as thinkers and innovators.40

Consumer academics Dr Louise Byrne and Professor Dame Til Wykes describe the value of
consumer‑led research:

commonly researchers from traditional backgrounds don’t understand the mental

health experience well enough to know how to approach participants or design
questions that are relevant and likely to receive meaningful responses. This is the crux of
the issue, why meaningful co‑production and lived experience leadership are essential
in any research. Lived experience provides a bridge, a means of translation between
mainstream research and service users.41

Australian National University academic, Dr Michelle Banfield, says that lived experience
researchers can break down the barriers between consumers and researchers, and in the
process, change perceptions about the importance of consumers in research.42

Principles of co‑design and co‑production are critical. These ensure that consumers are
involved from the outset; that power imbalances between participants are acknowledged
and addressed; and that developing the knowledge and capability of all involved is an
integral part of the process.43 Ms Georgie Harman, CEO of Beyond Blue, told the Commission
that such co‑design principles are integral to all stages of innovation if they are to respond to
the greatest needs:

Co‑design principles should be in place from the beginning to ensure that innovative
models meet genuine gaps and use approaches that are attractive to people that need
them. Involvement of people with lived experience must continue through the life of the
project, including in governance, implementing improvements and evaluation.44

It is the Commission’s strong view, shared by the Productivity Commission in its Mental
Health Inquiry Report, that people with lived experience should be involved in all stages
of development, trialling, monitoring and evaluation,45 to support the production of more
valuable services, programs and policies. This includes initial thinking and priority setting
through to co‑planning, co‑design, co‑delivery and co‑evaluation stages.46

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36.4.3  Diverse collaboration, partnerships and relationships

Adaptive systems create ways to bring people, ideas, information and expertise together to
learn, translate and scale what works. As Associate Professor Stafrace notes, an adaptive
system requires collaboration with a shared sense of purpose and challenge:

Delivering mental health services successfully is above all an adaptive challenge …

An adaptive response to the changing needs of the client requires interventions that
take into consideration the priorities of different stakeholders and lead to a common
understanding of what thriving entails in the setting of a new environment. It builds
on the past, changes through experimentation, draws in diverse perspectives, and
ultimately discards tightly held beliefs …47

The Commission’s interim report recognised that private sector competition and
partnerships can lead to improvements in service quality, innovative new service models
and better outcomes for consumers.48 Global analysis demonstrates that non‑traditional
players are disrupting traditional service delivery across industries. They are building new
capabilities to empower consumers and creating smoother service experiences.49

Analysts suggest that people outside of the healthcare system could soon be reshaping
models of business and care:

In a data‑ and technology‑enabled world, it is not a stretch to imagine that whole new
business models could be created by nonhealthcare players to deliver superior health
outcomes.50

Melbourne Connect, a purpose‑built innovation precinct led by The University of Melbourne

(refer to Box 36.3), observes that ‘[m]odern innovation flourishes when there is a convergence
of disciplines, skills and ideas.’51 Leading innovators from the Victorian start‑up community
echoed this view, advising the Commission that parties within and outside the mental health
system need to come together to generate and test new ideas.52

Where different people are coming together to solve problems, common goals and values are
essential.53 A review of successful research centres indicates that common goals and values
help develop a clear mission and rationale for building partnerships that motivate innovation
and ensure it can be applied in the real world.54 This includes partnerships with other national
and international academic organisations, entrepreneurs, businesses and local services.55
Including consumers and focusing on their needs also creates a unifying purpose.56

The What Works Centre for Wellbeing in the United Kingdom is an example of a growing clearing
house that functions by attracting a network of collaborators and innovators (refer to Box 36.4).

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Box 36.3:  Melbourne Connect

Melbourne Connect is a purpose‑built innovation precinct led by The University

of Melbourne.57 Melbourne Connect aims to bring together the digital expertise
of leading industry and University of Melbourne researchers to ‘create a culture
of excellence in ideation, knowledge sharing and sustainable innovation’ to find
‘solutions to our most pressing future challenges’.

Melbourne Connect will house the Melbourne Entrepreneurial Centre, including:

• the Melbourne Accelerator Program, which provides start‑ups with $20,000

equity‑free funding, office space and access to business programs and
supports to help accelerate their growth
• Translating Research at Melbourne (TRAM), a training function that uses
networks of entrepreneurs to provide professional development, mentoring
and ongoing support for researchers.

Another partner is the Melbourne Centre for Data Science, which aims to
collaborate across academia, the private and public sectors, research centres,
centres of excellence and research groups to lead innovation; and assemble
interdisciplinary teams to tackle long‑term or large‑scale projects.

The Melbourne Connect building is designed to attract tenant partners from

industry, government, research, talent and entrepreneurs as ‘true peers, equated
by a shared commitment to innovation, world‑class expertise and an appetite
for collaboration that will speed the process of bringing new thinking to life’. The
building design includes dedicated collaboration space, and The Telstra Creator
Space to develop prototypes and test early concepts ‘to drive ground‑breaking
innovation’.

Source: Melbourne Connect, <www.melbconnect.com.au>, [accessed 2 November 2020].

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Box 36.4:  What Works Centre for Wellbeing (United Kingdom)

The mission of the What Works Centre for Wellbeing, an independent

organisation, is to develop and share strong, accessible and useful evidence that
governments, businesses, communities and people can use to improve wellbeing.
Its team works closely with partners to answer important questions on what works
to improve wellbeing and to identify gaps in the research.

The centre is part of a broader ‘What Works Network’ and the Evidence Quarter.
These networks improve the way government and other organisations create,
share and use high‑quality evidence for decision making. Other members
represent a broad range of social policy areas, including health and social care,
education, justice, early intervention, economic growth and homelessness.

The Evidence Quarter aims to bring together centres to increase collaboration

and tackle joint challenges. Each evidence organisation has its own purpose,
but they share overlapping goals and face common challenges to do
with methodology, building movements and achieving change with their
research. The Evidence Quarter provides physical and virtual spaces to bring
organisations together to share resources and ideas, so that they more strongly
influence change.

Partners included in the Evidence Quarter are:

• national and local governments

• individual government departments and agencies
• universities
• economic and research bodies
• national and international commercial and not‑for‑profit entities
• investors
• health agencies, including the National Institute for Health and Care
Excellence.

Another partner is the Education Endowment Foundation, which helped establish

Evidence for Learning—a clearing house for global evidence on educational
practice—in Australia.

Sources: What Works Centre for Wellbeing, About Us, , <www.whatworkswellbeing.org/about-

us/>, [accessed 16 October 2020]; Evidence for Learning, Who we are and what we do, <www.
evidenceforlearning.org.au/about/who-we-are/>, [accessed 16 October 2020].

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36.4.4  Innovation that is enabled and supported

Innovation is required in Victoria’s mental health and wellbeing system to push the
boundaries of knowledge, as well as to explore new products and services that will lead to
better service quality, outcomes and economic value.58

International consulting firms recognise that the world is entering an era of exponential,
disruptive improvement in how consumers access health care, how providers deliver it, and
what outcomes it achieves.59 Much of this value will be created by innovation that enables more
community‑based delivery, more effective care delivery and improved clinical productivity.60

The Commission identified the conditions, structures and relationships (what it calls
‘enablers’) that are required to support innovation in a future, adaptive mental health and
wellbeing system. These are outlined in Figure 36.4.

Bring players together

Governments and the private sector are moving to support more rapid innovation that will
enable improvement in public and social services.61 Efforts are being made to create broader
networks, which are needed for public and social services innovation.

Governments have created departments and agencies to support innovation across a range
of service sectors, including transport, power, environment, health and education.62

In many instances, larger companies are partnering with non‑government organisations

or private mental health providers to offer new types of service models and pathways for
consumers. The Commission heard that companies such as Microsoft, Google and Twitter are
increasingly partnering with organisations such as Beyond Blue and Lifeline to provide new
services to consumers.63

There is a window of opportunity for Australia, as an early developer of e‑health self‑care tools,
to show leadership in this area. The Black Dog Institute told the Productivity Commission:

There is a timely opportunity for public sector‑led initiatives that can address questions
concerning trust and safety, equality of access, integration of data and ensuring data is
accessible rather than within the control of tech giants.64

A major trend in both general health care and mental health care is innovation‑led
entrepreneurship in the form of start‑up companies. The Commission heard from a number
of mental health entrepreneurs who were motivated to help build a more equitable service
system and have a positive effect on people’s lives.65

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Figure 36.4:  Major enablers of innovation

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Dr Haskelberg observed that people who engage with and work in the system are also
motivated to see it improve, so it is critical to involve them in innovation:

I believe real innovation comes from people who are part of the system and/or using the
services, and who have the drive and passion to make things better. It needs to be built
from the ground up …66

The Commission understands that people often discover new and better ways of doing things
while working in their day‑to‑day roles. The system must capture promising new approaches
that are developed on the ground, so that more people can benefit from these grassroots
innovations.

As Mr Edmund Phelps, winner of the 2006 Nobel Prize in Economics, said:

It’s very important to emphasise that most innovation comes from ordinary people,
not extraordinary. Some extraordinary people get lucky enough to produce some
innovation. But a lot of extraordinary innovations are the concepts of ordinary people.67

Create conditions to support innovation

Innovation requires flexible funding. Development and testing can be resource intensive, so
innovators need access to funding that accepts an element of risk in trialling, and properly
testing and assessing unproven approaches.68 A review of 60 successful healthcare reforms
across the world found that funding to test and scale innovation initiatives is a factor behind
longer‑term system improvement:

By funding projects that are initially modest in scale, and piloting or testing the
improvement initiatives, reformers can help shape the environment, preparing the ground
for later implementation of measures that can lead to systems‑wide enhancements.69

Innovation also requires regulatory environments that welcome new activity and are
responsive to change.70 More flexible regulatory approaches can provide greater opportunities
to design and test new ideas rapidly, and determine the right safeguards to use.71

Innovators told the Commission that health systems in the United Kingdom and Germany
provide a clear basis for reimbursing development expenses, empowering start‑ups to create
new tools for consumers. They still apply rigorous quality and safety standards. Innovators
also indicated that governments could learn from the way the private and start‑up sectors
safely manage concurrent implementation and testing of new interventions.72

Recognising and rewarding innovative practice can encourage people to participate in

innovation. Mr Frank Quinlan, former CEO of Mental Health Australia, giving evidence in a
personal capacity, said people need to know they are both encouraged and supported to
be innovative:

Innovation often happens on the fringes of the system which is absolutely welcome—
funding should be set aside to seed new ideas and spark experiments. However, we must
also provide people working within the system with enough certainty and stability to
learn from their mistakes.73

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Dr Haskelberg advised that clinicians should be provided with time and incentives for
research and development.74 Mr Clelland proposed the use of initiatives such as service
awards to recognise innovative practice. He said, ‘[y]ou cannot force people to innovate:
it is better to bring them along by recognising good practice and modelling it.’75

36.4.5  Research, knowledge and practice translation

The Commission’s interim report acknowledged the importance of ‘research that bridges
the gap between ‘discovery and practice’ [to] drive high‑quality care’.76 This involves three
distinct activities: translational research; knowledge translation; and practice translation. The
Cancer Institute NSW characterises these three stages as:

7. developing treatments and interventions

8. testing the efficacy and effectiveness of these treatments and interventions
9. dissemination and implementation for systemwide change.77

Together, these processes support cycles of learning that translate new knowledge into
practice, to improve consumer experiences and outcomes.78

A system that successfully translates evidence into practice requires feedback loops between
different types of research, services, government and consumers. This loop (refer to Figure
36.5) is what transforms knowledge into action and action back into knowledge, through new
or improved interventions and innovations in the system.79

In some cases, leading practice within the system may be more advanced than the
established research base. Therefore, feedback loops also need to capture, test and expand
learning and innovation that is taking place in different settings and services. Innovators who
met with the Commission said that effective loops also allow for rapid testing and adaptation
during the development of new solutions:

I think government[s] need to look to the start‑up community [for how to] concurrently
gather evidence and data so quickly … that you can actually make smart decisions
and pivots around the product as you go in a really safe, clever manner. [Technology
increases] the data feedback loop that’s so important to measure effectiveness … that’s
the kind of stuff that you can do … on the run.80

Ms Mary‑Ann O’Loughlin AM, Deputy Secretary, Skills and Higher Education in the New South
Wales Department of Education, speaking in her personal capacity, supports this approach:

Adaptive responses are also experimental: learn by doing, trial and error, with iteration
to improve response. Unique and shifting contexts require experimentation with real
time feedback and data about what is working, and then adjustment.81

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Figure 36.5:  Basic and translational research relationship

Innovators also advised that continuous feedback loops are essential to ensure that
promising and proven initiatives can be rapidly scaled, and that investment and
commissioning processes need to keep pace:

the current system is built for products that release once [and] don’t change … In terms
of both usability from a patient’s perspective, usability from a healthcare perspective,
effectiveness on outcomes, everything is tied against continuous improvement. And
that’s how good products are made … how we can create more of an iterative process to
policymaking that adapts to changing products and changing environments.82

36.4.6  A strong foundation of evaluation

capability and activity
Evaluation involves collecting, analysing and using information from a range of sources to
improve learning and decision making. When done well, it demonstrates what works and
what does not work, and for whom, in what context and why. When it is part of a continuous
improvement approach, evaluation supports good practice and policy. Evaluation can also
empower people whose voice might otherwise not be heard, by giving them a say about
decisions and services that affect their lives.83

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In general, evaluations tend to be carried out for three reasons:

1. to inform investment decisions84

2. to maintain accountability obligations for funding or other resources received85
3. to inform continuous improvement processes.86

Evaluation is a critical part of ensuring that a ‘learning system’ can respond to changing
needs, and of keeping policy and programs adaptive and responsive. As The Australian Policy
Handbook states:

A commitment to evaluation … emphasises that policy is iterative—an endless chain of

experiments and rethinking, as policies adjust to their changing circumstances.87

Professor David Castle a consultant psychiatrist at St Vincent’s Hospital and Professor of

Psychiatry at The University of Melbourne, advocates in a personal capacity for a continual
cycle of evaluation in relation to digital health care, which is increasingly important to a
contemporary system:

In respect of digital health care generally, we need to have a continual cycle of

assessment including reviewing uptake, acceptability and efficacy. This assessment is
apt for researchers and will help in developing, testing and validating the efficacy of
digital technology in mental health care. Research findings can then be disseminated to
provide guidance to consumers and providers, [and] users and potential users ...88

In an adaptive system, evaluation should be included as a regular part of program or service

design, as well as implementation from the beginning.89 It should also use success measures
that are established during the planning stage.90 This allows for an iterative development
process where evaluation findings inform ongoing adjustments. These can extend beyond
the implementation phase of a new program or service to support a deliberate approach to
continuing improvement.

In addition to co‑design and co‑production of new approaches, assessment of how well the
system is currently working and how it could be improved should include the views of those
it is designed for.91 Therefore, people who use services should lead and collaborate in their
evaluation.92

Ms Robyn Kruk AO, Interim Chair of Mental Health Australia, said in her personal capacity that
lived experience is one of the best sources of advice about flaws in the system:

Lived experience voices can provide insight on where the gaps and opportunities are in
delivery of the mental health system. From this perspective alone, having the voice of
lived experience built into decision‑making is logical from a first principles basis.93

The Australian Policy Handbook further emphasises that evaluation should be viewed as a
collaborative learning opportunity:

Evaluation teams should see their work as collaborative exercises, a learning

opportunity for all involved. The lessons generated will change the program before the
evaluation is complete.94

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The Commission shares the view of the Productivity Commission in its Mental Health Inquiry
Report that, to achieve continuing improvement, evaluation should be included in program
design implementation and delivery. This will ensure that programs make the best possible
contributions to mental health and wellbeing, and use public funds efficiently.95

The Productivity Commission notes that ‘[w]here evaluations of mental health programs have
been undertaken, they have tended to be ‘monitoring evaluations’ … [whereas] evaluations …
are most useful when they reveal the effectiveness or the ‘impact’ of a program.’96 It says this
is best achieved through randomised control trials that allow comparison between the group
of individuals who receive an intervention and a control group that does not.

This may not always be feasible or ethical, in which case alternative approaches should
involve ‘careful measurement of changes in mental health over time, controlling for any other
factors that change during the evaluation period’.97 The Productivity Commission argues that
state governments should undertake more impact evaluations, particularly based on trials,
ahead of broader rollout of programs.98

The Productivity Commission also recommends extending the functions of the National
Mental Health Commission to lead evaluations nationally in relation to ‘aspects of the system
that are of national significance or that relate to multiple jurisdictions’. The Productivity
Commission says that this does not rule out evaluating individual state or territory programs,
but ‘would involve close consultation with jurisdictions to discern where and when the
[National Mental Health Commission] could best add value’.99 It also stated that a national
evaluation function does not take away the primary responsibility of all governments to
monitor and evaluate programs.100

It is this Commission’s firm view that reflective and evaluative professional practice within the
workplace is also important. It is highly valued by people working in the system, and needs to
be enabled and supported across the workforce.101

To empower consumers and professionals as researchers and evaluators of their own

practice, they need the permission, knowledge and skills to measure and assess the effects
of new approaches on consumer experiences and outcomes. They also need support to
apply that learning in a process of continued practice improvement. This involves collecting
data and evidence, analysing the impact and adapting approaches based on the findings,
and reflecting on what has been learned about through undertaking the process—cycles of
learning that lead to growth in professional attitudes and practices.102

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36.4.7  Sharing and promoting what works

Using and sharing knowledge about what works effectively—from research, innovation
and evaluation—allows for better visibility of the suitability, efficiency and effectiveness of
programs and policies. This can inform decisions at system and service levels about investing
in and scaling proven approaches.

To ensure knowledge about what works is translated into equitable access to best practice
across the system, it is important that there is a definitive source of guidance and advice, where
a clear evidence base has been established. As Professor Alexander McFarlane AO, Professor
of Psychiatry in the School of Medicine at the University of Adelaide told the Commission in his
personal capacity, ‘there needs to be a system that actually treats people in a coordinated way
guided from the top by excellent co‑ordination of knowledge and research’.103

The National Institute for Health and Care Excellence in the United Kingdom (refer to
Box 36.5) runs a longstanding and successful model of this kind.

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Box 36.5:  National Institute for Health and Care Excellence,

United Kingdom

The National Institute for Health and Care Excellence (NICE) produces
evidence‑based recommendations by committees of experts, professionals and
members of the public across health and social care topics.

NICE publishes:

• clinical and practice guidelines

• quality standards that define clinical best practice
• advice and evidence about the latest medical and therapeutic innovations.

Topics for guidance are agreed with NHS England or the Department of Health
and Social Care, and then formally referred to NICE.

NICE coordinates an inclusive and consultative process that includes:

• developing and testing a draft scope

• collecting and reviewing literature and evidence
• preparing draft guidance and getting feedback from interested parties
for revisions
• formal sign off for publication by its Guidance Executive team
• carrying out regular reviews and updates of published guidance.

These guidelines are developed for a range of interested parties, including

practitioners, local authorities and service commissioners. Although practitioners
are expected to take NICE guidelines fully into account, they are not mandatory.

The development process is overseen by a committee of practitioners,

professionals, care providers, commissioners, consumers, and family members
or carers. The committee considers the cost‑effectiveness of programs and
interventions when developing NICE guidelines.

NICE has developed several guidelines for mental health and related conditions,
including depression in children and young people, generalised anxiety disorder
and panic disorder in adults, common mental health problems, and preventing
suicide in community and custodial settings.

Sources: National Institute for Health and Care Excellence , <www.nice.org.uk/>, [accessed 8 October
2020]; National Institute for Health and Care Excellence, Developing NICE guidelines: the manual,
<www.nice.org.uk/process/pmg20/chapter/introduction>, [accessed 12 October 2020]; Productivity
Commission, Mental Health Inquiry Report, Volume 3, pp. 1239–1240.

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36.5  Strong potential

but some missing features
The Commission acknowledges that Victoria has resources and expertise to support the
system to evolve and reform. However, they are not currently working together to achieve
their collective potential.

The state has a diverse range of independent bodies and experts engaged in mental health
research, and is well recognised in a number of mental health research fields.104 In its interim
report, the Commission recognised the valuable contributions of many bodies—including
Orygen, the Victorian Institute of Forensic Medicine, and headspace’s Discovery College—
and Victorian health services, universities and foundations who are collaborating with them
to research and improve mental health treatment, care and support.105 Many others are
highlighted throughout this report.

Further, Victorian legislation, health service performance frameworks, and departmental

guidance and resources acknowledge evaluation and evidence‑based program and policy
development.106 Healthcare innovation is gaining momentum, representing the largest
start‑up environment in the state.107

Based on evidence received and consultations conducted, the Commission is convinced

that the knowledge and expertise required to strengthen Victoria’s mental health system
already exist or are emerging. As stated in the Commission’s interim report, there is a need to
bring these together, and ‘develop a culture of improvement and research … which combines
clinical, academic and peer leadership and seeks interdisciplinary collaboration’.108

Unifying this expertise and experience will reposition Victoria as a leader in mental health
and wellbeing research and innovation, able to attract further eminent expertise, and secure
available funding and resources to undertake pioneering work.

However, the current system struggles to support widespread innovation and continuous
improvement. In particular, the Commission considers that the system lacks the structures
and processes needed to bring together and use the available intelligence and expertise to
the greatest possible effect. As a result, the mental health system is not adapting quickly to
evidence about what works in practice, and Victorians are not benefitting from this evidence
in the services they receive.

This was summed up in a submission from Alfred Health:

the current system is not geared for constant learning, improvement and change so that
it can meet the needs of service users and communities. The system finds difficulty in
drawing on publicly funded researchers, quality improvement specialists, clinicians and
people with lived experience to be part of the research process … there is limited public
investment in research and training and there is no coordination of outputs, priorities
and desired research.109

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The collaborative centre will be a pivotal addition to Victoria’s ability to grow the research
base and support the translation of research evidence into practice through collaborative
methods.110 This new landscape reflects many of the functions required in an adaptive
system. However, other capabilities will need to be established to fully develop and use new
knowledge and evidence.

The following section outlines the aspects of the current system that need strengthening,
in order to become truly adaptive.

36.5.1  Diverse contributions

The Commission heard that the current mental health system is failing to use diverse sources
of expertise—including people who interact with and work in the system—to progress system
and service improvement.

While there is a strong basis for consumer research capability in Victoria, the voices of
experts and people with lived experience are not given enough power within the current
mental health system. Consumer‑led research is often not given priority, or enough funding
or commitment, and it has ‘no real power to set agendas, influence decision‑making, or bring
about structural change’.111

The Commission was told of consumer researchers being required to align with unrelated
disciplines, such as nursing or social work, in order to find support to develop research or
projects that are fully grounded in what matters to consumers.112

Ms Roper advocates for more consumer academics, because ‘[t]hese roles are key influencers
of mental health workforce practices and policies and can achieve so much more if further
embedded in other academic settings.’113 She argues that a lack of influence means research
agendas can overlook issues that are most important to consumers:

consumer perspective in policy and research are not well developed areas in Victoria
and need investment. There is also a need for consumer led research … which prioritises
the research areas of interest to consumers … [A]dopting human rights perspectives in
mental health research … tends to matter most to consumers who have the least control
over research agendas. This needs to change ...114

As a result, consumers say that research can fail to use their strengths or to respond to
their needs:

Currently, consumers are often excluded from innovation. Innovations often meet
clinical and carer, but not consumer needs. The process for developing these innovations
often occurs without our involvement, let alone co‑design or co‑production. And there
seems little space for us to set the agenda, by developing our own innovations to meet
our strengths and needs.115

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Ms Indigo Daya, Consumer Academic, Centre for Psychiatric Nursing at the University of
Melbourne, says in her personal capacity that one cause of this is that consumers are not
invited to participate early enough in the process:

Most commonly … we’re invited to join a research project, after the funding and ethics
(and therefore major decisions) have all been made.116

The underrepresentation of consumers in research is compounded by the fact that

traditional forms of testing and evaluation by large organisations are more likely to gain
funding, exposure and validation than non‑traditional researchers.117 Associate Professor
Atkinson observes that locally generated and non‑traditional research still struggles to
secure resources.118

Victorian innovators warned that funding was not reaching the most likely sources of
innovation, with one saying:

There’s clear funding out there, it’s just not directed into the right areas. And we think
about the [Medical Research Future Fund which] has significant capital. But of course,
it’s still directed towards universities.119

In a meeting with the Commission, LaunchVic innovators stated that they saw the current
hierarchical biomedical model as unwelcoming to new voices, ideas or technology. This stifles
opportunities for new contributions and solutions:

I think one of the biggest barriers is the outdated and very hierarchical medical model …
so how are we actually going to shake out that model and bring in new thinking? I think
the biggest missing link is … that there is no connector … so how do we actually get these
ideas heard and accepted … how do we make it part of the system rather than just a
nice to have?120

The Commission also heard that the mental health workforce is not supported to develop and
improve models of care. Professor Ian Hickie AM, Co‑Director, Health and Policy at the Brain
and Mind Centre at the University of Sydney, reported in his personal capacity that reflective
practice is often not prioritised within services, and that the ‘system has somewhat stultified
the personal drive in individuals to engage in innovation and development’.121

As discussed in section 36.6.1, joint clinical academic leaders—clinically active health

researchers funded by the Victorian government—have researched and developed new ways
of delivering better outcomes for the people they treat and care for over several decades.122
However, Orygen argues that the joint clinical academic leadership model, which was
designed to support workforce development projects and expand the crossover between
research and practice, has ‘fallen into disrepair’. It argues that professional isolation and a
lack of support has made it ‘unproductive academically and translationally’.123

Professor Suresh Sundram, Head of Department of Psychiatry in the School of Clinical

Sciences at Monash University and Director of Research of the Monash Health Mental
Health Program, calls in his personal capacity for more multidisciplinary clinical academic
leadership roles (most are currently held by psychiatrists), and for these leaders to be given
more prominence.124

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In the Commission’s view, this could include currently underrepresented research groups,
including clinical psychology, specialist mental health nursing, occupational therapy, social
work, and consumer academic leaders.125

36.5.2  Funding and investment to generate improvement

A lack of funding, resources and promotion of innovation within the Victorian mental health
care system is stifling a culture of exploration and creativity.126

Australian mental health research has demonstrated a strong economic return from
investment. One study of Australian and international research investments found that the
returns were two to three times higher than for cardiovascular disease and cancer.127 However,
funding allocated to mental health research is out of step with the prevalence and impact of
mental health conditions in our community.128

The Commission heard about the de‑prioritisation of mental health investment, planning
and improvement, compared to other forms of health.129 In its interim report, the Commission
noted that mental health receives less funding and attracts less investment in research than
physical health problems, such as cancer, diabetes and cardiovascular disease.130

Cancer attracts around twice the amount of research funding from the Commonwealth
Government,131 and up to 2.5 times more from the National Health and Medical Research
Council.132 Since 2016–17, just 1.1 per cent of the Medical Research Future Fund grants have
been committed to mental health.133 Mental health research also receives comparatively low
support from corporate, community, family foundations and private charitable trusts.134

In its submission, Orygen noted that the recent introduction of the Commonwealth’s Million
Minds Mental Health Research Mission fund has boosted investment, but mental health
continues to be underfunded compared to other health areas, both nationally and globally.135
Other submissions contend there is relatively little funding for mental health research.136

The Productivity Commission states that ‘[r]eliable estimates of the total amount of
research funding in mental health are unavailable due to the variety of funding sources and
differences in reporting’, but that Commonwealth Government funding for mental health
research has increased in recent years. This includes $15 million to support mental health
research in the 2017–18 budget, and $12 million to establish a National Suicide Prevention
Research Fund. National Health and Medical Research Council funding has grown around
fivefold from 2000 to 2019, when mental health and addiction expenditure of $110.2 million
comprised 16 per cent of the Council's expenditure on the Australian Government’s National
Health Priority Areas.137

Mental health research funding is summarised in Figure 36.6.

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Figure 36.6:  Mental health research funding summary

Source: National Mental Health Research Council Corporate Plan 2019–20; Medical Research Future Fund 10-year plan;
Million Minds Research Mission (Department of Health); Victorian Medical Research Acceleration Fund (Health Vic);
Victorian Government 2018–19 budget papers; Australian Rotary, Funding Breakdown, <www.australianrotaryhealth.
org.au/home/funding-breakdown>, [accessed 20 November 2020].

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Underinvestment in mental health research at state, national and global levels has meant
that advances in understanding about the causes of mental illness, and better ways to
manage and treat mental illness, have been described as ‘negligible’.138 In particular, new
treatments and drug therapies fall far behind other areas of medicine, such as cancer and
cardiovascular disease treatment (refer to Box 36.6).139

Box 36.6:  The importance of research and innovation in pharmacology

The development and widespread use of medications to treat mental illness or

psychological distress began in the 1950s. New drug therapies made independent
living and community‑based care a viable option, and became an important
factor in the deinstitutionalisation of people living with mental illness in
Australia.140

However, Professor Arthur Christopoulos, Professor of Analytical Pharmacology

at Monash University, advised the Commission in his personal capacity that
there have been no truly novel medicinal breakthroughs in treatments for mental
illness or psychological distress over the past 50 years.141 Further, Professor Patrick
McGorry AO, Professor of Youth Mental Health at the University of Melbourne and
Executive Director of Orygen, told the Commission that improvements in new
treatments and drug therapies for mental illness have not been made available.142
One consequence is that side effects of mental health drugs continue to have a
significant impact on the physical health and social wellbeing of consumers.143
Further, research into modern medications may benefit workforce retention, as
morale of staff is impacted when they perceive that available treatments do not
help the consumer.144

In 2017–18, complaints about medication constituted 19 per cent of new

submissions to the Mental Health Complaints Commission.145 A common concern
was that medication side‑effects were not being adequately considered or
responded to.146 For example, many psychotropic medications are known to
dramatically increase appetite, resulting in physical health challenges including
weight gain.147 Other side effects include insomnia, drowsiness, excessive
thirst, swallowing difficulties, social withdrawal, muscle spasms and lack of
coordination.148 Other pharmacology issues raised included interactions between
pain medication and psychiatric medications and the effects of psychiatric
medication on potential pregnancies.149

The Association of Counselling Psychologists raised concerns to the Productivity

Commission about ‘diagnostic inflation’, whereby a large percentage of people
presenting to GPs with mental health concerns receive prescriptions for psychiatric
medication despite limited assessment and little or no impact on symptoms.150
Antidepressants are widely used treatments for major depressive disorder,
despite long‑lasting debate and concern about their efficacy.151 Back in 2008, a
meta‑analysis found that the ‘epidemic’ use of antidepressants was supported by
‘a seemingly evidence‑based myth’ generated by inadequate research:

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the use of many small randomized trials with clinically non‑relevant

outcomes, improper interpretation of statistical significance, manipulated
study design, biased selection of study populations, short follow‑up, and
selective and distorted reporting of results has built and nourished a
seemingly evidence‑based myth on antidepressant effectiveness.152

Other researchers have claimed that over‑reliance on psychopharmacology

‘created the conditions for a blindness towards the serious adverse effects
of some psychiatric drugs [and allowed] the illusion of major innovations in
antipsychotic drugs’.153

Meanwhile, advances in other areas of medicine have created opportunities for

mental health research that are going unrealised. For example, genetics research
has provided fundamental insights into schizophrenia. However, further research
and investment in pharmaceuticals using these developments is needed to make
meaningful progress on new treatments.154

The Productivity Commission found that more research into the clinical benefits
and long‑term health implications of mental health medications ‘could generate
significant improvements in mental healthcare treatment outcomes’.155

Therefore, the Royal Commission considers that research and innovation in

psychopharmacology is of crucial importance to ensure that consumers receive
appropriate, evidence‑based treatment without harmful side‑effects. Other
priorities for research and innovation are discussed in section 36.6.5.

Submissions from research bodies confirmed that a lack of funding and the low assignment
of priority for mental health research has contributed to slow translation of evidence‑based
models of care into practice.156 The Florey Institute of Neuroscience and Mental Health said
that more support is needed for translational or participatory research:

At a fundamental level, the quality of treatments for mental disorders hinges on the
successful translation of basic science research to clinical interventions. Yet the
translational gap … to implementation at the bedside remains a significant issue …
A major impediment between the bench and bedside is the cultural and academic
divide between basic and clinical research, and the resultant difficulty in successfully
translating research through to the point where it is available for use by the public.157

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Professor Shitij Kapur, Dean of the Faculty of Medicine Dentistry and Health Sciences, and the
Assistant Vice Chancellor for Health at the University of Melbourne, argued in his personal
capacity that this support must come from within Victoria:

We are not really leveraging funding for [translational research]. The reason for this
is that there are currently not many national or international agencies that will fund
that research. Therefore, if Victoria wants translational and implementation science
research, if it is a priority, Victoria will need to pay for it.158

The need for more research into mental health and wellbeing is increasingly understood, and
levels of research funding in Australia for mental health are higher than ever and growing.159
Establishing the collaborative centre, and building strong and diverse networks of research
expertise, will put Victoria in a strong position to attract and secure research funding, and
grow its reputation as a research leader.

There also appears to be a lack of funding and impetus for evaluation, particularly at the
community level.160 The Productivity Commission observed in its Mental Health Inquiry Report
that ‘Australia generally has a lack of routine program evaluation and evidence gathering
to inform funding allocations and program improvements in mental health … [a]nd where
evaluations are undertaken, it is not clear if they are used to improve programs.’161

The Australian Psychological Society contends that ‘lack of investment in quality outcome
evaluations means the effectiveness of much of the expenditure on mental health remains
unclear’, and calls for outcome evaluation of programs and services provided by the public
mental health sector to be mandated and routinely undertaken.162

Foundation House said more support is needed for evaluation of community‑based programs
and initiatives in Victoria:

Evaluation and research must be resourced if they are to be undertaken at all or

effectively. The Victorian Government provides in‑kind support for some research
partnerships but … [f]urther investment is required. Among other areas, community
based agencies undertaking mental health projects commonly require external
assistance to design and implement evaluations of their work.163

Expert evidence also suggests that a lack of funding and resources, and low assignment of
priority for innovation within the system, is stifling a culture of exploration and creativity.164

Victorian innovators have said it is hard to find opportunities, resources and support for
innovation, and ways to translate it into practice:

Often peer alternatives are trapped in a Catch‑22 where the argument against
commissioning alternative models of care is based on them having a less established
evidence‑base compared to other models, and yet it is often difficult to get substantial
funding to research consumer‑led alternatives to build that evidence base.165

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I think the big challenge is, so many organisations, I think, fall through the cracks of
being able to access the support and funding … how can we provide quick, agile paths to
funding for organisations that are probably a bit smaller? And on the coalface? And how
can we equip them with the skills and the know‑how to be able to put their hat in the
ring to even access these sorts of opportunities? 166

Mr Graham Panther, witness and co‑founder of the Big Feels Club, told the Commission
that government funding often comes with excessively restrictive requirements that force
innovators to find financial support from outside the system:

to truly build your offering with your users, you have to go into it not knowing what your
solution will be … The money we’ve accepted has been money that came with few strings
attached … This has allowed us to experiment in a way that we could not have if we were
funded via health funding.167

36.5.3  Culture and conditions that support innovation

Dr Haskelberg warns that the public system is seen as very risk‑averse.168 Ms Harman also
observes a culture that does not trust the ‘new’, or reward risk‑taking, which limits the scale
and uptake of innovation:

[There is] enormous pressure on innovative enterprises to demonstrate success. Yet, a

major influence on innovation is being allowed to try new things and fail … This doesn’t
mean that we shouldn’t do such things, but … may mean we need to consider learnings,
failures and partial successes, rather than only looking at outcomes.169

Innovators who met with the Commission also perceive low levels of government trust and
confidence in small and non‑traditional enterprises:

[Government needs to recognise] that there’s significant technologies and start‑ups

out there with solutions that can save lives and help people feel much better. But we just
fear it, unless it comes from a large branded organisation we’re not going to buy it. And
this is a problem.170

Innovation is often hampered by a lack of evidence and outcomes in the early days of
development, which is required to secure resources for further development. Professor
Lisa Brophy, Discipline Lead in Social Work and Social Policy, Department of Occupational
Therapy, Social Work and Social Policy at La Trobe University, observed in a personal
capacity that this can undermine innovative approaches before they are able to
demonstrate value:

Often when implementing new models of care, the model is corrupted by the impact
of having insufficient resources to properly analyse its impacts and see it flourish.
New innovations must be supported on a continued basis, so they can be given the
opportunity to operate as intended.171

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As a result, consumers and carers, or smaller innovation organisations, are often not eligible
or able to scale up their ideas and evaluate them:172

There’s all of these announcements about … new funds to support innovation and
support collaboration. But very few start‑ups or NGOs [non‑government organisations]
are eligible … it means that we end up with the same old solutions all the time. So it has
to … come completely out of those systems, and into a completely new environment. 173

The Black Dog Institute identified other barriers to innovative and digital solutions that exist.
These include:

• a lack of encouragement for industry involvement

• failure to work with clinicians on expectations and benefits
• a lack of confidence in quality, safety and evidence
• concerns about potential legal liabilities
• governments and users being unwilling to pay.174

Even where an innovation is developed and receives a positive evaluation, it often lacks the
investment and support required to make it widely available.175 This can discourage further
innovation. Ms Harman explained:

Successful projects need to be scaled up and integrated within wider service systems.
Running short term, small scale pilots that never reach scale despite positive
evaluations becomes a significant disincentive to further innovation.176

The Florey Institute of Neuroscience and Mental Health, and Professor Mario Alvarez‑Jimenez,
Director at Orygen Digital, cite research indicating that it takes 17 years to move research
innovation into clinical practice.177 Even then, 85 per cent of innovations never reach those
who need them.178 A major cause of this delay is the cultural divide between clinical research
and basic research (which includes local innovation).179

Innovators told the Commission that the failure to sustain and grow proven innovations
creates inefficiencies, because effort and resources are wasted on reinventing approaches:

[Start‑ups have] got technologies with solutions out there already. And they fall over
after a couple of years, because we just don’t have the ability to get adopted into the
system … And so, then we invent the wheel, and we do another one … we’re just going to
see this constant circulation of failure happening.180

The Black Dog Institute pinpointed self‑help technologies as one area where successful ideas
are not being picked up and invested in:

e‑health programs and apps are … effective, cost‑effective and can be scaled up
cheaply … Although these products are effective, they are underused even when the
need is high … There are many more specialised digital services that have been created
but do not receive Government funding for scale up or roll out.181

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However, while the system has been slow to encourage and adopt innovations, many people
have chosen to access information and support through digital, multichannel and flexible
sources. This has been accelerated during the COVID‑19 pandemic.182 Beyond Blue,183 the Black
Dog Institute,184 and the Clinical Research Unit for Anxiety and Depression at the University
of Sydney185 all report increased demand for digital mental health tools and resources. For
example, the online cognitive behavioural therapy program, THIS WAY UP, has experienced a
700 per cent increase in the number of individuals accessing the courses.186

In Victoria, area mental health services delivered 346 consumer contacts via teleconference
in April 2019. A year later, this number increased to over 10,000 consumer contacts.187 The
growing use of online communities such as The Big Feels Club clearly indicates these
alternative supports are meeting a consumer need for other options to clinical care.188

Professor Kapur stated that the integration of lived experience, and digital and technological
leadership could place Victoria ‘at the cutting edge’: 189

I think it is feasible for us to be at the cutting edge of digital mental health here
in Victoria. It is not just about medicine, it is about getting a lot of input from our
sociologists, our historians, our ethicists, our lawyers, and of course our mental health
professionals, along with the community of people with lived experience. We have a
strong tradition of it in Australia and I think Victoria could amplify it.190

While some innovation will happen organically through investment in research and the
translation of new knowledge into practice, the Commission believes there needs to be more
disruptive innovation that reflects the views and preferences of consumers. The mental
health and wellbeing system needs to create flexible funding and regulatory environments
that encourage invention, risk‑taking and controlled trial and error, in order to find new and
effective approaches to mental health treatment, care and support.

36.5.4  Dedicated innovation support

Innovation is carried out within the system (by academics and services) or outside of the system
(between private organisations, non‑government organisations and individual entrepreneurs).
There is no space or platform in Victoria to bring together consumers, innovators, mental
health services, accelerators and investors dedicated to mental health innovation.
The Victorian Government accepts that these parties are not being formally supported to
promote continuous development and improvement of mental health services together.191

The Commission believes that spaces and funding opportunities must be created to
encourage collaborative experimentation, learning and solution design. LaunchVic has
observed that parties want to come together with the system to contribute, but they
do not know how to do this. They are also often overwhelmed by the complexity of the
environment.192 Innovators told the Commission that these supports will need to be carefully
chosen and organised, and have the flexibility and openness to enable consumers, smaller
innovators and non‑traditional researchers to participate with other experts:

If there was a facilitator of passionate and talented and capable innovators to have a
safe place to play, it kind of opens up the other side of the funnel … I think it’s a huge
catalyst to unlocking a whole amount of, like really passionate, really smart, really
capable people not being scared away …193

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36.5.5  Knowledge and practice translation support

The Commission heard that a lack of coordination and collaboration between different
research institutions and levels of government prevents research and evidence being
translated into policies, programs and on‑the‑ground practices.194 Ms Kym Peake, then
Secretary of the Department of Health and Human Services, observed that evidence‑based
approaches are not being systematically translated into practice across the system:

There is also strong and consistent evidence supporting specific therapies and …
specialist therapeutic interventions … These interventions are not systematically
embedded in … models of care ...195

Professor McGorry emphasised that the failure to translate evidence into practice means
consumers miss out on the most effective treatments, and may be exposed to unproven
alternatives.

The evidence‑base for mental health care has improved a lot in recent years, however
fewer and fewer patients get exposed to this. Examples include clozapine, cognitive
behavioural therapy (CBT), individual placement and support (IPS), assertive community
treatment (ACT), family interventions and home‑based treatment. Non‑evidence based
models have emerged, such as [emergency department] based admission beds, to replace
models that were evidence‑based, such as home based treatment of acute episodes.196

The Commission is concerned that, as a result, services may continue using outdated treatment
and delivery models that do not meet the needs of consumers, families, carers and supporters.

The collaborative centre will need strong connections with service delivery organisations
across the state to translate research into practice. Currently, limited academic and clinical
connections exist at a service level to build these networks.197 Without translation at the
service level, the benefits of research, innovation and evaluation will not be realised.

The Commission recognises the need for dedicated resources to support, capture and scale
innovation that is happening on the ground, so that practitioners and small organisations
are able to contribute to the evidence base.198 Feedback loops and connections to decision
making are also needed to ensure the system is equipped to use local innovation to develop
and test policies. To effectively trial and test new approaches, and then validate and scale
proven innovation, it is important to develop inquiry and assessment skills throughout the
system to support learning and evaluation activities, along with leadership capability to
enable high‑quality reflective practice.199

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36.5.6  Sources of evidence and information

In 2017, the former Department of Health and Human Services identified that no organisation
had direct authority to practically support the translation of mental health research and
other knowledge into better ways to deliver treatments, supports and best practice.200

The Commission considers that the system still lacks a function that brings a diversity of
knowledge and evidence together. This includes knowledge and evidence from the research
community, and system data and evaluation, as well as from the expertise and experiences of
consumers, carers and staff.

Dr Shaymaa Elkadi, Executive Director of Strategy, Planning and Performance at Forensicare,

noted that the lack of a knowledge system is a problem for consumers, researchers and
innovators:

There are currently very archaic data and knowledge systems in place in the mental
health system. These systems are not integrated and prevent the sharing of information
across services in the clients’ best interests as well as effective research and
innovation.201

In its interim report, the Commission stated that this knowledge‑translation gap is ‘a
deficiency that must be redressed’.202 This will require the creation, synthesis and sharing of
data, evaluation findings and evidence‑based guidance, as well as support and resources to
implement it in practice.

The Productivity Commission in its Mental Health Inquiry Report similarly noted that the
collection and use of outcomes data is crucial to making improvements. It observed the
mental health system has been criticised for being ‘data rich but information‑poor’, and said
‘[m]uch more can be done to improve the collection and use of mental health data to inform
decision making and improve outcomes for consumers and carers.’203 It noted that ‘program
evaluations in mental health across Australia are, for the most part, ad hoc, uncoordinated
and lacking in objective evidence’.204

The Commission agrees, and considers that evaluation is not being systematically used as a
tool for continuous improvement.

The former Department of Health and Human Services released an evaluation guide that
promotes the use of evaluation before, during and after the implementation of programs.205
The Commission has seen evidence of many impact and outcome evaluations carried out
for specific programs and local service innovations within Victoria’s mental health system.
However, it is not clear whether this information is used to invest in and expand effective
initiatives. This requires: evaluation that incorporates collecting feedback from consumers
and practitioners; and the system using evaluation findings to adapt new initiatives and
maximise their potential benefit.

In fact, there appears to be little system‑level evaluation to determine the collective and
independent effects of mental health services on consumer and carer outcomes, or on
system sustainability. The Victorian Auditor‑General’s Office noted in 2019 that a formal
evaluation framework for the government’s 10‑year mental health plan (launched in 2015)
was yet to be completed.206

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There is also no function to formalise ‘definitive’ evidence on behalf of the system to guide
the translation of research into practice. There are many examples of practice guidance
and standards that relate to particular professions, service settings or diagnoses.207
However, to ensure all consumers can choose or experience a consistent, high standard
of care, the mental health and wellbeing system needs a function to publish authoritative,
evidence‑based practice guidance that can be applied more universally.

Innovators said that without this, there is uncertainty about what is effective and supported:

it’s really hard to get information on what’s evidence-based, what’s supported by

the government, what has evidence behind it, what doesn’t, and that leads to … big
uncertainty … for self-management tools … what patients should look for themselves,
and leaves a lot of inability to find the correct things.208

As detailed in Chapter 11: Supporting good mental health and wellbeing in the places
we work, learn, live and connect, there is a broader need for authoritative advice to help
other community sectors and organisations better support people’s mental health and
wellbeing. For example, the Commission was advised that frameworks and programs which
support mental health and wellbeing are inconsistently applied across early childhood and
school settings,209 and that ‘accreditation’ of evidence‑informed initiatives would greatly
assist schools.210

Similarly, participants in the Commission’s Mentally Healthy Workplaces Roundtable said that
businesses need guidance and clarity about how to support the mental health and wellbeing
of their workers, and that it is unclear which workplace interventions are effective.211

The lack of authoritative evidence also makes it harder for objective, consistent and
evidence‑based policy design and investment decisions to be made at system, regional and
service levels.

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36.6  Supporting research,

innovation and system learning
The Commission believes that continual development, innovation and adaptation will be
central to the effectiveness of Victoria’s mental health and wellbeing system.

As Alfred Health argues, ‘[m]uch is still unknown about the causes and treatments of
mental illness’.212 Therefore, Victoria’s mental health and wellbeing system must be set up
to continue learning:

[Victoria’s mental health system] must be explicitly designed for learning and
improvement, with the capacity to monitor performance, evaluate services and
innovation and undertake research into new knowledge through engagement with
academics, patients and clinicians.213

Figure 36.2 presents the recommended functions and relationships for a mental health
and wellbeing system that innovates, learns and adapts. It outlines arrangements that are
designed to:

• build the culture and capabilities needed to encourage collaboration, courage and
reflection
• bring together interdisciplinary experts, researchers, service leaders and people with
lived experience to carry out research, translate it through service delivery, and share
knowledge to improve treatment, care and support across the system
• support collaborative innovation, and assist with the application of new and proven
approaches to treatment, care and support
• collect, combine and share evidence and lessons learned about effective practice
to continually develop service design, policymaking and investment, to improve
experiences and outcomes.

Collectively, these functions will enable an adaptive, responsive system that is designed for
current realities, but has an inbuilt capacity for self‑review and adjustment if it is not meeting
future needs or achieving expected outcomes.214

36.6.1  Translational research and dissemination

The Commission views the establishment of the collaborative centre as an opportunity
to create a networked approach to research and knowledge translation within the future
system. As a new entity, the collaborative centre will model an open and inclusive culture
of research that gives primacy to the needs, interests and expertise of the people that the
system is designed to support.

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Working with established research organisations, including those featured in this and other
chapters, the collaborative centre will bring together people with lived experience, and a
broad range of multidisciplinary experts and researchers to develop, translate and share best
practice across the system.215 Working closely together, this network of research organisations
will collaborate on further research into priority needs in the system, and bridge gaps
between research and practice. They will share the objective of making world‑class
treatment, care and support widely available to Victorians in the future system.

A promising example of a networked approach that brings together research, clinical and
lived experience expertise to improve services and outcomes for Victorians is the Change to
Improve Mental Health Centre of Excellence (CHIME) partnership between Barwon Health and
Deakin University (refer to Box 36.7).

During its early deliberations, the Commission recognised established research expertise
and activity in Victoria, relating to mental illness in children and young people (refer to
Box 36.8). It identified a clear gap in current translational research focused on adults and
older Victorians.

The collaborative centre is designed to fill this gap. It will lead translational research, and
provide mental health and wellbeing services to adults (from 26 years) and older adults.
This remit, including people aged 65 years and older, will align with the adult and older
adult mental health and wellbeing system recommended in Chapter 5: A responsive and
integrated system and Chapter 14: Supporting the mental health and wellbeing of older
people. The collaborative centre will work closely with existing research bodies—such as the
National Ageing Research Institute—to ensure that available expertise is used to develop the
evidence base.

It has been suggested to the Commission that there is less translational research for infants
and children (aged 0–11) and there would be benefit in creating the system‑wide capability
equivalent to the collaborative centre for children and younger people aged 0–25.

The Victorian Government should identify and promote opportunities to increase

collaborative translational research between multiple organisations and multidisciplinary
experts, and people with lived experience, to improve the mental health and wellbeing of
infants, children and young people across Victoria.

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Box 36.7:  Change to Improve Mental Health Centre of Excellence

Barwon Health has established a new type of translational research partnership

with Deakin University called CHIME (Change to Improve Mental Health Centre
of Excellence), that places people with lived experience at the forefront. CHIME
aims to leverage the deep community connections of both organisations to
drive innovation and collaboration in mental health care and to improve access,
services and outcomes for rural and regional communities in the Barwon area.

Associate Professor Steve Moylan explained the purpose of this networked

research approach:

CHIME aims to engage people with lived experience of mental illness,

clinicians and academics in co‑design and co‑production of models of
care, and to build capacity for evidence‑based continuous improvement
of mental health services within the region ... The partnership will create a
regional ‘Learning Healthcare System for Mental Health’. Underpinned by
systems thinking … It will drive transformation in mental health services in
regional Victoria.

Research projects engage clinical staff from Barwon Health into Deakin’s
research team, enhancing knowledge exchange across both organisations and
diversifying the skills, experiences and perspectives of all involved.

Initial research collaborations through CHIME include:

• using data to understand risk factors for poor mental health for youth in
the region to inform early intervention measures
• clinical research into the efficacy of particular interventions (such as
diet and exercise) as part of mental health treatments and models of
care. The aim is to both improve mental health outcomes for rural and
regional consumers and at the same time address common co‑morbidities
associated with mental illness such as cardiovascular disease
• evaluation of the rollout of mental health telehealth services in the region
in response to the COVID‑19 pandemic.

Future research priorities for CHIME include integrating digital capabilities such
as artificial intelligence in the development of new therapies and technologies;
and working with IMPACT (Deakin’s Institute for Mental and Physical Health and
Clinical Translation), to expand opportunities for consumers, families, carers
and supporters across the region to participate in mental health clinical trials,
and enhance the Barwon community’s access to world‑leading treatment, care
and support.

Sources: Interview with Associate Professor Steven Moylan, Barwon Health and Renae Carolin, Interim
Director – CHIME, 14 December 2020; Barwon Health, CHIME (Change to Improve Mental Health Centre
of Excellence), <www.barwonhealth.org.au/research/our-research/item/chime-change-to-improve-
mental-health-centre-of-excellence>, [accessed 15 December 2020].

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Box 36.8:  Collaborative research—children and young people

The Commission, in its interim report, identified a particular need for research
focused on treatment, care and support for adults and older Victorians. It
recommended that this be the focus of translational research led by the
collaborative centre. In doing so, the Commission recognised that within Victoria,
there are already bodies with established reputations and expertise in the
fields of infant, child and adolescent mental health that could partner with the
collaborative centre and other bodies in networks and communities of practice.

The Murdoch Children’s Research Institute is Australia’s leading child health

research organisation that translates knowledge into effective prevention and
treatment strategies across a range of disorders.

The Institute is also the custodian of research within the Melbourne Children’s
Campus—a strategic and physical alignment including the Institute, the Royal
Children’s Hospital, and the University of Melbourne’s Department of Paediatrics
co‑located with the Royal Children’s Hospital Foundation. The Foundation
supports clinical trials and research with the aim of improving mental health
provision on the campus.216

The Institute helped establish the Centre for Research Excellence in Childhood
Adversity and Mental Health, a five‑year research program co‑funded by the
National Health and Medical Research Council and Beyond Blue, to support
multidisciplinary and community‑based approaches to child mental health.217
During 2020, the Victorian Department of Education and Training partnered with
the Institute and the Ian Potter Foundation to develop and pilot evidence‑based
training and resources to help staff better identify and respond to mental health
issues affecting primary school students (refer to Chapter 11: Supporting good
mental health and wellbeing in the places we work, learn, live and connect).218

Orygen is Australia’s largest mental health research entity. It focuses on early

intervention and treatment for mental illness in young people.219 Orygen’s
translational research capability spans discovery, novel treatment, clinical trials,
service delivery, health economics and practice improvement research.220

Orygen has established a reputation as ‘one of the world’s leading research

and knowledge translation organisations focused on mental ill‑health in young
people’,221 and is involved in a range of international research partnerships and
activities.

During 2018–19, Orygen delivered clinical and non‑clinical services training and
consultations to workforces in Ireland, Hong Kong, New Zealand and the United
States.222 In 2019, it also co‑hosted the International Association of Youth Mental
Health’s fifth International Conference.223

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Orygen also partnered with the World Economic Forum as part of the Forum’s
initiative to develop a global youth mental health model, and to ‘put youth mental
health on the global agenda for the World Economic Forum Annual Meeting in
Davos 2020’.224

In 2018–19, Orygen delivered clinical services for more than 3,500 young people
(aged 12–25) at four headspace centres in the north and north‑west of Melbourne.
It was involved in 36 research projects, published more than 200 articles, led
17 clinical trials, delivered 15 training programs and events, and supported 250
young people in its youth participation programs.225

In April 2020, the Victorian Government announced funding for Orygen to

implement its Moderated Online Social Therapy (MOST) program across all
state‑funded child and adolescent youth mental health services, and all Victorian
headspace centres (refer to Chapter 34: Integrating digital technology).226 In the
same year, Orygen secured a $33 million grant from the United States’ National
Institutes of Health to develop models for predicting outcomes for young people
who are at imminent and high risk of psychotic illness.227

Research translation

The collaborative centre and other research partners will carry out applied research through
their respective service delivery arms, including testing it in different contexts and settings.

To support knowledge dissemination and implementation of research findings, the

Commission recommends that the Victorian Government strengthen the joint clinical
academic model by expanding and diversifying the cohort of clinical academic leaders, and
strengthening the supports provided to them (refer to Box 36.9). The collaborative centre
will build a network of academic leaders to translate, test and apply research in the areas of
greatest need, through a regional hub‑and‑spoke model.

Professor Sundram and Professor Emeritus Bruce Singh AM, Clinical Director, Mental Health
Services at South West Healthcare Warrnambool, advised in their personal capacities
that embedding clinical advocates of research and translation within the service system
is essential to create a strong translational research culture.228 Professor Sundram also
observed that it is important to build a research culture in the workforce, so that clinicians
‘will become alive as to how research will improve practice’.229 He noted that this is a challenge
in the current system:

At present, the difficulty is that research is hitting a cold workforce, one that has no
experience with research. There is antagonism towards research, with many clinicians
seeing it as a burden on their day to day work. The only way to overcome this is to
embed research into mainstream practice.230

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Orygen suggested that restructuring and better investing in leadership academic posts
would greatly improve research translation on the ground. It would also build the critical
mass needed to generate change.231

The Commission believes these clinical leadership positions need greater respect, support
and assignment of priority by universities, service providers and government to be effective.

Box 36.9:  Joint clinical academic positions

Clinical academics have been described as:

clinically active health researchers. They work in health and social care as
clinicians to improve, maintain or recover health while in parallel researching
new ways of delivering better outcomes for the patients they treat
and care for.

Clinical academics also work in higher education institutions, while

providing clinical expertise to health and social care. Because they remain
clinically active, their research is grounded in the day‑to‑day issues of their
patients and service. This dual role also allows the clinical academic to
combine their clinical and research careers rather than having to choose
between the two.232

Clinical academic positions are designed to fulfil a number of leadership, clinical

activity, training and research functions, including:

• raising the profile and prestige of mental health services

• improving the quality of services
• undertaking high‑quality research and disseminating research findings
• seeking to effectively translate research, knowledge and outcomes
into practice
• contributing to the recruitment and retention of quality staff
• providing clinical leadership to the Victorian mental health workforce.233

The introduction of the first clinical academic positions fostered some of

Victoria’s most influential mental health leaders and voices in the system.234
Advancements under their leadership (such as Orygen’s considerable
improvements in the youth space) can be partially attributed to these positions
and the opportunities they afforded.

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In 2018–19, the former Department of Health and Human Services invested over
$4.7 million in clinical and non‑clinical academic positions, with funding allocated
to a range of service agencies. This clinical academic program funded around
30 mental health clinical and non‑clinical academic positions (suitably qualified
clinicians who have both an academic role within a university and a senior
clinical role within specialist mental health services) to provide clinical leadership
in mental health, and promote innovation through a range of workforce
development and knowledge translation projects.235

Authoritative evidence, guidance and advice

The Commission recommends that the Victorian Government gives the collaborative
centre responsibility for creating a ‘clearing house’ to bring together high‑quality data and
learning from research, evaluations and innovation relating to mental illness in adults and
older people.

The purpose is to combine and promote evidence about proven and effective treatment, care
and support. This will inform policy development and investment at the system level, and
service design and commissioning by Regional Mental Health and Wellbeing Boards. It will
also provide a source of reliable and contemporary evidence and information to local, area
and statewide services, innovators and the general public.

These evidence synthesis and publication activities could be modelled on the National
Institute for Health and Care Excellence (described in Box 36.5) and the What Works Centre
for Wellbeing in the United Kingdom (described in Box 36.4).

Topics for guidance will be self‑determined or referred to the collaborative centre by the
Department of Health or the Mental Health and Wellbeing Commission, and informed by
phases of reform and research priorities.

Other research bodies may also be mandated to perform similar activities relating to
evidence about mental illness in infants, children and young people in the future. The
networked model within which organisations will work can ensure that promising innovations
and validated approaches across the lifespan will be identified, captured and integrated
where appropriate into authoritative evidence and guidance.

The guidance and advice that is developed could include systematic reviews and other
synthesised research evidence of the effectiveness of clinical and non‑clinical approaches
to mental health treatment, care and support; guidance on adopting new, evidence‑based
therapeutic innovations; tools and resources to support evidence‑based professional
practice; and operationalising and implementing culturally responsive and recovery‑oriented
care in partnership with consumers, families, carers and supporters, as modelled by the Yale
Program for Recovery and Community Health (refer to Box 36.10).

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The Department of Health should establish processes to ensure the guidance from the
collaborative centre and any other mandated research partners is used to inform the
assignment of priorities for policy development; integrated in commissioning and planning
cycles; and made available to service and system oversight functions.

In undertaking these roles, the collaborative centre and other research centres will be well
placed to contribute to, and benefit from, interjurisdictional work led by the National Mental
Health Commission to build the evidence base in mental health—part of the Productivity
Commission’s recommendations for a significantly strengthened national evaluation
environment.236

Box 36.10:  Yale Program for Recovery and Community Health

The Yale Program for Recovery and Community Health—part of the Connecticut
Mental Health Center of the Department of Psychiatry at Yale School of Medicine—
conducts research and evaluation in the areas of recovery from serious mental
illness, substance use, citizenship, social inclusion, and health disparities
and equity.

The Program for Recovery and Community Health research and evaluation is
rooted in community work and connections. It is developed as a learning activity
in partnership with people, families and organisations across the boundaries that
academic disciplines and diagnostic labels can at times create.

The program ‘has developed a national and international reputation as a leader

in articulating, operationalising and implementing culturally responsive and
recovery‑oriented care … by:

• researching innovative and effective community and peer‑based services

and supports
• assisting systems of care in becoming more culturally responsive and
recovery oriented
• reducing health care disparities
• improving individual, agency and system‑level outcomes’.

Source: Yale School of Medicine, Yale Program for Recovery and Community Health, <www.medicine.yale.
edu/psychiatry/prch/about>, [accessed 26 August 2020].

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36.6.2  Dedicated support and resources

for innovation and practice translation
For the future mental health and wellbeing system to continuously evolve, it needs more
collaborative innovation. New, promising and proven approaches need to be applied more
readily to treatment, care and support across all service settings and age ranges. This will
require creating collaborative innovation networks supported by flexible funding, to expand and
diversify networks between mental health consumers and services, innovators and investors.

Collaborative networks should:

• be made up of a flexible and evolving group of partners from different fields of national
and international expertise (including lived experience, technology, private investors
and organisations, mental health services and government)
• use a ‘collective impact’ framework to bring people and organisations together to
solve problems
• focus on supporting co‑design and co‑production with consumers and carers
• allow for rapid design and testing of new ideas that demonstrate strong alignment with
consumer, carer and system needs
• offer resourcing and support to people or small organisations with inventive ideas.

A new mental health and wellbeing innovation fund should reflect the model and principles
of the Better Care Victoria Innovation Fund, which supports sector‑led innovation and
improvement projects in the Victorian health sector.237

The mental health and wellbeing innovation fund will:

• be flexible, providing the initial funding to test new ideas, and encourage
creative exploration and testing, without needing a fully established theory or
guaranteed outcome
• require alignment to principles of co‑design and co‑production, and fund
consumer‑led initiatives238
• respond to clearly defined system problems and support innovators to raise and tackle
new challenges
• establish a funding stream for ‘spreading and growing’ good ideas that demonstrate
effectiveness, and provide financial and technical support to scale them.239

The innovation fund and networks should be coordinated through an existing entity that has
the culture and conditions to foster new ideas and approaches. It should be arm’s length from
government, and visibly and culturally separate from formal research and system entities,
including the collaborative centre. This is so that innovation initiatives can attract a diverse
range of partners, allow flexible ways of working, and promote non‑traditional inquiry to help
build the evidence base.

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The coordinating body will ensure the funding and activities for mental health and wellbeing
innovation are aligned with system needs and expectations, including a commitment to
consumer leadership, and provide meaningful support to a variety of service providers and
service systems to implement, test and evaluate new approaches in various settings.

CivVic Labs is a local example of collaborative innovation. It provides a space for entrepreneurs
and government to come together to tackle identified problems (refer to Box 36.11).

Box 36.11:  CivVic Labs (a LaunchVic and public sector collaboration)

LaunchVic is Victoria’s state start‑up agency. It was established by the Victorian

Government in March 2016 as an independent agency responsible for developing
a globally connected start‑up ecosystem for Victoria.240 To date, the agency
has committed $45.6 million in Project Activities funds through grant rounds,
sponsorship and other commissioned activities.241

LaunchVic partnered with the Victorian Government and its Public Sector
Innovation Fund to create the CivVic Labs accelerator. CivVic Labs provides a
space for government and start‑ups to come together to solve identified public
sector challenges.

A government department or agency submits a challenge to the start‑up

ecosystem through the lab and invites suggested solutions from Victorian
start‑ups. The best ideas are chosen by the government department for
refinement, and the best approach is then selected for acceleration.

Start‑ups work within the accelerator to build a version of a product with

just enough features to attract investment and provide feedback for future
development. The accelerator provides funding, mentors and resources. Start‑ups
can secure up to $30,000 to develop their idea, and $150,000 to scale and
implement the solution on the ground.

While government sets the ‘challenges’ to be solved, the solutions are brought in
from outside thinking, and are not prescriptive.

Source: <www.civvic.launchvic.org/the-program> [accessed 13 November 2020].

The innovation body must have the expertise to identify leading practice wherever it
emerges, and to test and develop promising innovation. It should also partner with the
Department of Health and relevant regulators to ensure the right conditions for safe
yet flexible testing. This will allow new ideas to be designed and tested quickly, and for
appropriate safeguards to be progressively determined.242 Such an approach also allows
regulators and innovators to determine what regulatory changes may be required to ensure
they deliver projects safely.243

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The innovation body will support developmental testing and assessment of promising
initiatives. It will also identify to the Department of Health, innovations that have the
potential to be shared more widely for greater benefit. The department will be responsible for
ensuring independent evaluation of innovative approaches, as part of a defined process of
decision‑making and investment, to scale proven approaches and provide equitable access
across the system. This will include translation and innovation efforts by area partnerships
and local services that are funded by Regional Mental Health and Wellbeing Boards.

The innovation body will also be responsible for supporting practice translation—applying
knowledge and guidance on the ground, and embedding effective innovation in routine practice.
Alfred Health says that services need to have the capacity to develop and test new ideas:

we also believe that every Area Mental Health Service (AHMS) must have capacity to use
data, patient, family and clinician feedback to develop ideas for improvement, rapidly
test and evaluate them in practice and then spread those ideas in order to generate
learning about what changes, in which contexts actually work.244

Drawing on the example of Ontario’s Rapid Improvement Support and Exchange model, the
innovation body will provide practical tools and support to translate new innovations, and
both promising and evidence‑based models and guidance, into service delivery at area and
local levels.

It will support organisations and service providers through coaching and step‑by‑step
capability building in assessment and testing, and empower workforces and professionals,
including lived experience experts, as researchers of their own practice.

These supports will be informed by established approaches and methodologies to implement

improvement processes, such as the Institute for Healthcare Improvement’s Model for
Improvement promoted by Safer Care Victoria.245 The methodologies draw on a body of
‘implementation science’ literature, which recognises that improvement efforts are more
successful when structured processes are used. These processes are most effective where
they have the commitment of senior leadership, and are implemented by frontline staff,
based on local data and co‑designed with consumers.246

Other system supports for implementing quality improvement are discussed in more detail in
Chapter 30: Overseeing the safety and quality of services.

If successful, this practical support model could be extended to local and regional
implementation of the Commission’s recommendations more broadly, and where needed.

The Victorian Government should design processes to support regional commissioning that
encourages innovation in areas of need by area partnerships and local services, and also to
collect information from Regional Mental Health and Wellbeing Boards about local service
needs, activity or improvement.

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36.6.3  Build evaluation activity and

capability across the system
Evidence‑based decision making is a key principle of the Public Health and Wellbeing Act
2008 (Vic).247 In Victoria, the consistent use of evaluation to determine the effectiveness
and cost effectiveness of interventions, policies and programs is one of the primary tools to
ensure the health system, including mental health, delivers on this obligation.248

The Commission considers that including evaluation mechanisms to continually measure

and improve service responsiveness and effectiveness is critical to the success of the future
system.249 This reflects the Commission’s seventh guiding principle for Victoria’s mental
health and wellbeing system:

Mental health services use continuing research, evaluation and innovation to respond to
community needs now and into the future.

As previously stated, it is the Commission’s view that the system must respond and adapt to
inequity within it. This includes making leading practices and approaches available across
the system, in line with the Commission’s third guiding principle:

Comprehensive mental health treatment, care and support services are provided on
an equitable basis to those who need them and as close as possible to people’s own
communities—including in rural areas.

The Commission is concerned that the failure to validate, sustain and grow proven
approaches is denying Victorians the best possible treatment, care and support. Mr Alan
Woodward, witness, believed that this failure also worsens inequity when best practice
interventions are available to some consumers, but are not made widely available:

My concern is that while some regions in Victoria have benefited from trials, there
needs to be more consistency across the State. As the trials move into the delivery of
services phase, there needs to be an application of what is being learnt from them and
translation into more consistently improved services for all Victorians, regardless of
where they live.250

Austin Health said that the system needs services to evaluate local improvements, and
that expectations about evaluating and sharing learnings should be made clear as part of
funding arrangements:

Good governance calls for robust evaluation of all activities and trials undertaken within
the mental health system, with a particular focus on identifying and sharing learnings
from those events. Where a health service has made an attempt to improve services,
or a discovery of a new way of overcoming an issue, there should be mechanisms in
place for sharing or collaborating these breakthroughs and innovations … [for funded
programs] reporting against expectations should be required … following completion
with results and learnings promulgated appropriately.251

Therefore, the Commission places great value on effective evaluation at all levels of the
system, and capturing new ideas and approaches from research and innovation, wherever
they may occur.

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Under the Mental Health Act 2014 (Vic), the Secretary of the Department of Health has
responsibility to ‘monitor and evaluate the performance, standards and outcomes of mental
health service providers and the quality and safety of the mental health services they provide’. 252

The Mental Health and Wellbeing Commission recommended in Chapter 27: Effective
leadership and accountability for the mental health system—new system‑level governance
will be responsible for system performance oversight. This includes monitoring and reporting
on system‑wide outcomes, and on the Victorian Government’s progress in implementing the
Commission’s recommendations and delivery of reforms.

The Department of Health will remain accountable for monitoring and evaluating the
performance and outcomes of mental health and wellbeing service providers. This must
include ensuring that new service and program funding depends on clearly communicated
and appropriate levels of spending on evaluation, and on independent evaluation findings
being shared to promote system learning.

The Commission also recommends that the Department of Health:

• develops a rolling three‑year evaluation program (similar to the Productivity

Commission’s proposal for the National Mental Health Commission to publish a rolling
three‑year schedule for evaluation253) and commissions appropriately qualified and
independent experts to carry out evaluations of mental health and wellbeing programs,
initiatives and reforms
• carries out or commissions the evaluation of innovation projects funded from the
mental health and wellbeing innovation fund, or through targeted investment by
Regional Mental Health and Wellbeing Boards in local innovation or translation
initiatives
• in partnership with the workforce development coordinating function of the
collaborative centre (described in Chapter 33: A sustainable workforce for the
future), builds evaluation capability across the system, including raising the profile of
consumers and carers as evaluators
• sets an expectation that adequate evaluation is a condition of funding for all new
mental health and wellbeing programs, initiatives and innovations, and that this
expectation extends to the sharing of evaluation findings for wider system learning
• establishes processes to share information from evaluations and innovation learning
through the collaborative centre and other research centres, to promote and scale
proven approaches across the system.

The Commission notes that the Centre for Evaluation and Research in the former Department
of Health and Human Services carries out evaluation activities across a range of programs.
This supports policy and program development, as well as the continued improvement of
services. However, due to the scale of mental health and wellbeing system reforms, and the
need for extensive evaluation activity in the future, the Commission recommends resourcing
dedicated capacity for mental health and wellbeing evaluation.

More systematic evaluation is needed to understand how to apply models of care in widely
varying cultures and settings.254 Without this, evaluation activity may create inequity in the
mental health and wellbeing system. For example, trials of a program at limited sites could
give different results in different areas. This may lead to some services being discontinued
and others continued, causing inconsistency in access.255

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As a result, the Department of Health should report evaluation findings publicly.256 It should
ensure that processes are in place to use them proactively in system and policy design.

The Institute for Safety, Compensation and Recovery Research provides a model for how
government and service providers can partner with expert evaluators and researchers to
inform continued review, refinement and implementation of what works (refer to Box 36.12).

Box 36.12:  Institute for Safety, Compensation and Recovery Research

The Institute for Safety, Compensation and Recovery Research is a joint initiative
established and funded by Monash University, WorkSafe Victoria and the
Transport Accident Commission (TAC). The purpose of the Institute is to lead
exploratory and translational research that can inform real‑life policy and service
improvements for member organisations.

Working closely with WorkSafe and the TAC, Monash University co‑develops
its research approach and questions to understand the issues they face and
how to answer them. One of the major services that WorkSafe, the TAC and
Monash University provide is the development and implementation of evaluation
frameworks and activities to assess the effectiveness, outcomes, and effects or
lessons for any government program and initiative that WorkSafe and TAC use,
and for the outputs of the evaluations to inform policy and investment decisions.

The benefits of this model are that government has a large network of experts
who can inform evaluation and continuous improvement. The TAC and WorkSafe
do not have major in‑house evaluation capabilities or ethics functions. Therefore,
this approach ensures that all programs and services are properly and
independently assessed. Evaluation outcomes can also be fed back into research
to improve future service design and outcomes.

Source: Institute for Safety, Compensation and Recovery Research, Our partners and Governance,
<www.iscrr.com.au/who-we-are/our-partners-and-governance/>, [accessed 20 August 2020].

The Commission also notes the Productivity Commission’s recommendation in its

Mental Health Inquiry Report that a national body should be responsible for promoting
a culture of evaluation, commissioning program evaluations, and building evaluation
capacity and capabilities.257 This body—recommended to be the National Mental Health
Commission—would build and maintain partnerships with research institutes, and state and
territory partners:

the [National Mental Health Commission] is expected to evaluate aspects of the system
that are of national significance or that relate to multiple jurisdictions. This would
involve close consultation with jurisdictions to discern where and when the [National
Mental Health Commission] could best add value.258

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There would be an opportunity for a dedicated mental health and wellbeing evaluation
function in Victoria to form a strong relationship with the national body, and access funding
to undertake program evaluations that would have national interest.

Support provided for practice translation by the clinical academic leaders’ network, and
local innovation and trials by the innovation body should include helping to establish
models of ongoing testing, reflection and adaptation within teams—reflecting structured
processes such as the RISE rapid improvement model. They should also build the skills of
workers and consumers to reflect on and evaluate different approaches and implications for
their practice.

Intelligence gathered from evaluations, consumer‑led research and leading grassroots

practice should also be used by the workforce development coordination function of
the collaborative centre to inform the design and development of capacity building and
professional development.

36.6.4  Integrating consumers and

the workforce in system learning
In Chapter 27: Effective leadership and accountability for the mental health system—new
system‑level governance, the Commission recommends that the new Mental Health and
Wellbeing Commission develops and implements strategies to support the leadership,
and the full and effective participation, of people with lived experience of mental illness or
psychological distress in decision‑making processes about policies and programs, including
those directly concerning them.

The collaborative centre, other research bodies, the Department of Health, and the
innovation body should all ensure that consumers have a meaningful and influential role in
research and evaluation, and that consumer expertise is built into research efforts, service
innovation and workforce capability development.

Consumer leadership will be integral to networked collaboration. The collaborative centre will
employ leaders with lived experience in influential positions in many of its functions, to help
grow the body of consumer‑led research, and ensure that promising findings are put into
practice for the benefit of consumers, families, carers and supporters.259

Proactive efforts must be undertaken to support and build the capabilities of consumers as
leaders of research and evaluation.

Consumer leaders must have a senior presence in the governance of innovation,

implementation and evaluation responsibilities. They should influence how funding is shared
and encourage lived experience experts as partners in the innovation networks.

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As described in Chapter 33: A sustainable workforce for the future, the collaborative centre
will work with existing learning and development providers, and statewide services to
coordinate and increase access to high‑quality workforce training and development. This will
be for all staff in the Victorian mental health and wellbeing system, including consumer and
peer workforces. It will include:

• developing leaders to support adaptive thinking and practice

• building workforce capabilities for reflective practice, collaborative inquiry and
evaluation, focused on improving consumer experiences
• building best‑practice guidance and evidence‑based approaches into
training programs
• supporting the workforce to participate in knowledge distribution and evidence‑based
practice approaches.

Associate Professor Stafrace argues that ‘[t]he techniques of adaptive thinking can be taught
and learnt.’260 In his view, the ‘ability to recruit adaptive leaders or develop adaptive leadership
capability will be crucial in building the capacity for reform in our mental health sector’.261

36.6.5  Research priorities and opportunities for innovation

Research and innovation activities that receive Victorian Government funding should be
clearly linked to system reforms, and consumer needs and preferences. It is the Commission’s
view that directing research and investment to focus on these areas, summarised in Box 36.13,
will support implementation, and advance new and improved approaches to treatment, care
and support.

Overall, the system should have the capacity to respond to breakthroughs that may not be
part of the formal research agenda, but that have the potential to add considerable value
for consumers. This includes responding to unexpected events or needs within the Victorian
community.

The Commission is confident that, by taking these steps to strengthen research, innovation,
practice translation and evaluation, Victoria’s mental health and wellbeing system will be
set up to learn, adapt and improve into the future, and regain its status as a world‑leader in
mental health treatment, care and support.

Box 36.13:  Research and innovation priorities for

the Victorian mental health and wellbeing system

Community‑based models of care: as a foundational reform, it will be critical that

research supports the investment and expansion that will be required, and builds
evidence on approaches to particular service delivery modalities, peer support
methodologies, supports for particular groups in communities (for example,
refugees), and opportunities for supporting mental wellbeing, particularly relating
to isolation and loneliness.262

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Children and young people: the future system will provide treatment, care and
support earlier in life, and earlier in an individual’s experience of mental illness—
including increasing wellbeing and preventing poor mental health. Research
into the role of psychosocial factors early in life, and effective wellbeing and
treatment interventions, will help to improve outcomes for young people. In
particular, a stronger understanding of the links between substance use and
mental health, and effective interventions for children and young people who
have experienced trauma, will help the system to better respond to those most at
risk of mental illness.263

Digital technologies and innovations: there is significant potential to improve

access and service delivery through the integration of digital technologies
into clinical services, but more translational research is needed to realise this
potential. Research into digital interventions that enhance clinical services,
mechanisms that influence take up and adoption, and effectiveness of digital
tools and interventions, will be foundational to achieving a contemporary system
and responding to the needs of regional and rural communities.264

Diverse communities: The Commission has made a number of recommendations

that target the mental health and wellbeing of people who are at greater risk of
poor mental health, trauma and suicide than the general population. Research
is needed to develop and adapt culturally appropriate and safe models of
care and interventions to meet the particular needs of Aboriginal people,265
culturally diverse communities including migrants and refugees from different
backgrounds,266 and LGBTIQ+ communities.267

Families, carers and supporters: the future system will respond to the significant
role that relationships of care and support play in promoting mental health and
wellbeing for people living with mental illness or psychological distress. Research
will provide a stronger understanding of the crucial role that parents, families
and other carers and supporters play, the challenges they face, and how their
experiences can strengthen how services are offered and delivered. It will also
inform the development of dedicated supports that the system will offer to
families, carers and supporters.

Older Victorians: the collaborative centre will create research capacity in Victoria
that is dedicated to developing the evidence base for improving the mental
health and wellbeing of older adults. This will enable the system to provide more
effective interventions aimed at improving help‑seeking, facilitating diagnosis
and increasing participation in enjoyable and meaningful activities.268

Pharmacology: further research is needed to make meaningful progress on

new treatments and drug therapies for mental illness (see Box 36.6 above for a
detailed assessment).269

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Rights and interests of consumers: the Commission’s recommendations make

the rights of consumers paramount. Services will be required to significantly
reduce the use of compulsory treatment, and work towards eliminating seclusion
and restraint. They must be supported to develop a stronger understanding
of alternative interventions and strategies that are safe and effective.270 More
broadly, additional research will inform approaches and initiatives that effectively
deal with stigma and change attitudes towards mental illness.

Suicide prevention and support: suicide prevention research has been effective
in describing risk factors, but the Commission understands there is still much to
learn about the effectiveness of suicide prevention interventions. Research will
be critical in helping the system to reduce the rates of self‑harm and suicide,
particularly among younger people. It is also important to better understand
family and carer experiences of caring for someone who is suicidal, and how the
system can help people who provide this support.271

Trauma: along with suicide prevention, trauma‑informed practice and services

are prioritised in the immediate actions recommended by the Commission.
The establishment of a statewide specialist trauma service auspiced by the
collaborative centre (refer to Chapter 15: Responding to trauma) creates an
opportunity for more translational research into responses and interventions
for survivors of torture and traumatic events, and to develop holistic, culturally
adapted approaches suitable for diverse communities and consumers.272

Treatment and services for people with mental illness needing ongoing intensive
treatment, care and support: there are some people whose mental health
outcomes are substantially worse than the general population, and who would
benefit from accelerated research and new care models to support them. The
Commission considers that the needs of these Victorians should be a paramount
concern, as evidence indicates that many experience high levels of coercion, poor
physical health, and personal recovery outcomes and social exclusion.273

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1 Royal Commission into Victoria’s Mental Health System, Interim Report, 2019, pp. 98 and 385.
2 Evidence of Dr Ravi Bhat, 15 July 2019, p. 988.
3 Royal Commission into Victoria’s Mental Health System, Interim Report, pp. 391–393.
4 Productivity Commission, Mental Health Inquiry Report, Volume 3, 2020, p. 1246.
5 Productivity Commission, Mental Health Inquiry Report, Volume 3, pp. 1244 and 1246.
6 Productivity Commission, Mental Health Inquiry Report, Volume 3, p. 1246.
7 Australian Bureau of Statistics, 4159.0 General Social Survey: Summary Results, Australia, 2014, 2015, <www.abs.gov.
au/statistics/people/people-and-communities/general-social-survey-summary-results-australia/latest-release>,
[accessed 25 September 2020]; Australian Bureau of Statistics, 1370.0 Measures of Australia’s Progress, 2013, <www.
abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/1370.0~2013~Main%20Features~Homepage~1>, [accessed
25 September 2020].
8 Commonwealth Department of Infrastructure and Transport, State of Australian Cities, 2013, pp. 7–8 and 271–272.
9 Australian Council of Social Service, Inequality in Australia: A Nation Divided, 2015 Part 1: Income Inequality;
Australian Council of Social Service Part 2: Wealth Inequality; Vinson, Rawsthorne, Beavis and Ericson, Dropping
Off the Edge 2015: Persistent Communal Disadvantage in Australia, 2015, p. 11.
10 Department of Health and Human Services, Victoria’s 10–Year Mental Health Plan, 2015, p. 10; John Mendoza,
Kathleen Margaret Griffiths and Sebastian Pascal Rosenberg, Obsessive Hope Disorder: Reflections on 30 Years of
Mental Health Reform and Visions for the Future: Summary Report, 2013, p. 41; Witness Statement of Kym Peake, 24
July 2019, paras. 57 and 74; Victorian Auditor-General’s Office, Access to Mental Health Services, 2019, p. 8; Mercy
Mental Health, Submission to the RCVMHS: SUB.0002.0029.0267, 2019, p. 4; Witness Statement of Dr Neil Coventry,
28 June 2019, para. 118.
11 Witness Statement of Angus Clelland, 5 June 2020, paras. 15–20; Witness Statement of Associate Professor
Alessandra Radovini, 10 June 2020, para. 54; Witness Statement of Dr Hila Haskelberg, 13 July 2020, paras. 84 and
100; Witness Statement of Georgie Harman, 2 July 2020, para. 59; Witness Statement of Professor Mario Alvarez-
Jimenez, 10 June 2020, paras. 159 and 167.
12 Monash Sustainable Development Institute, Correspondence to the RCVMHS: CSP.0001.0102.0001, Final Outcomes
Report, 2020, pp. 13–14.
13 Monash Sustainable Development Institute, p. 14; Witness Statement of Dr Hila Haskelberg, para. 84.
14 Witness Statement of Angus Clelland, para. 143.
15 Witness Statement of Professor Ian Hickie AM, 11 August 2020, paras. 185–186; Witness Statement of Angus
Clelland, para. 14.
16 Monash Sustainable Development Institute, Monash University, Correspondence to the RCVMHS:
CSP.0001.0103.0001, A Primer Paper: Forces Shaping Victoria’s Mental Health System, 2020, pp. 20–21.
17 LaunchVic, About LaunchVic, <launchvic.org/about-launchvic>, [accessed 6 October 2020].
18 Better Care Victoria, Better Care Victoria Innovation Fund, <www.bettercare.vic.gov.au/our-work/innovation-fund>,
[accessed 6 October 2020].
19 Victorian Council of Social Service, Social Impact Bonds Briefing Paper, 2017, pp. 1–2.
20 Department of Treasury and Finance, Partnerships Addressing Disadvantage, <www.dtf.vic.gov.au/funds-
programs-and-policies/partnerships-addressing-disadvantage>, [accessed 3 March 2020]; Witness Statement of
Georgie Harman, 2020, para. 80.
21 Victorian Government, Victorian Budget 2020–21: Service Delivery: Budget Paper No. 3, 2020, p. 118.
22 Shubham Singhal and Stephanie Carlton, The Era of Exponential Improvement in Healthcare?, 2019, p. 4.
23 Fiona McKenzie and Mark Cabaj, Changing Systems, Power and Potential, 2020, p. 9.
24 Harvard Business Review, Disruptive Technologies: Catching the Wave, <hbr.org/1995/01/disruptive-technologies-
catching-the-wave>, [accessed 26 October 2020].
25 Australian Institute of Family Studies, Collective Impact: Evidence and Implications for Practice, <aifs.gov.au/
cfca/publications/collective-impact-evidence-and-implications-practice/what-collective-impact>, [accessed 20
October 2020].
26 Forbes, What Is A Startup?, <www.forbes.com/sites/natalierobehmed/2013/12/16/what-is-a-startup/>, [accessed
26 October 2020].
27 Productivity Commission, Draft Indigenous Evaluation Strategy, 2020, p. 5.
28 Monash Sustainable Development Institute, Monash University, p. 4.
29 Monash Sustainable Development Institute, Monash University, p. 26; Ministry of Health, Ontario, Ontario Health
Teams: Guidance for Health Care Providers and Organizations; K.A. Moat, K. Waddell and J.N. Lavis, RISE Brief 11:
Accountable-Care Organizations, 2019.
30 Ministry of Health, Ontario, p. 5.

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31 McMaster University, Rapid-Improvement Support and Exchange, <www.mcmasterforum.org/rise/learn-about-rise/

overview>, [accessed 6 October 2020].
32 Witness Statement of Associate Professor Simon Stafrace, 14 August 2020, paras. 143 (a–e).
33 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 109.
34 Witness Statement of Dr Hila Haskelberg, para. 81.
35 Lynne Maher and others, Creating the Culture for Innovation: A Practical Guide for Leaders, 2010, p. 9.
36 Witness Statement of Associate Professor Jo-An Atkinson, 29 April 2020, para. 92; Jo-An Atkinson, Andrew Page,
Ante Prodan, Geoff McDonnell and Nathaniel Osgood, ‘Systems Modelling Tools to Support Policy and Planning’,
The Lancet, 391.10126, (2018), 1158–1159 (p. 1159).
37 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 111.
38 Alison Faulkner, ‘Survivor Research and Mad Studies: The Role and Value of Experiential Knowledge in Mental
Health Research’, Disability and Society, 32.4, 2017, 1–21 (pp. 10 and 12).
39 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 410.
40 Witness Statement of Cath Roper, 2 June 2020, para. 34.
41 Louise Byrne and Til Wykes, ‘A Role for Lived Experience Mental Health Leadership in the Age of COVID-19’, Journal
of Mental Health, 29.3, 2020, 243–246 (p. 244).
42 Michelle Banfield and others, ‘Lived Experience Researchers Partnering with Consumers and Carers to Improve
Mental Health Research: Reflections from an Australian Initiative’, International Journal of Mental Health Nursing,
27.4, (2018), 1219–1229 (p. 1220).
43 Cath Roper, Flick Grey, and Emma Cadogan, Co-Production: Putting Principles into Practice in Mental Health
Contexts, 2018, p. 6.
44 Witness Statement of Georgie Harman, 2020, para. 77.
45 Productivity Commission, Mental Health Inquiry Report, Volume 3, pp. 1113 and 1249.
46 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 410.
47 Witness Statement of Associate Professor Simon Stafrace, 2020, paras. 51 and 53, citing Heitetz R Grashow A
and Linsky M, The Practice of Adaptive Leadership. Tools and tactics for changing your organisation the world
(Harvard Business Press, 2009).
48 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 433.
49 Dr Stephanie Allen, 2020 Global Health Care Outlook: Laying a Foundation for the Future, 2019, p. 4.
50 Singhal and Carlton, p. 6.
51 Melbourne Connect, Access Leading Researchers, Talent and Entrepreneurs, <melbconnect.com.au/people/
access/>, [accessed 2 November 2020].
52 RCVMHS, Innovation Roundtable: Record of Proceedings, 2020.
53 Monash Sustainable Development Institute, Monash University, pp. 21 and 24.
54 Victorian Government, Melbourne Biomedical Precinct: From Research Engine to Economic Powerhouse, 2018, p. 7.
55 Victorian Government, Melbourne Biomedical Precinct: From Research Engine to Economic Powerhouse; Monash
Health, Monash Health Translation Precinct, <monashhealth.org/research/translation-precinct/>, [accessed 14
October 2020]; Garvan Institute of Medical Research, About the Garvan Institute, <www.garvan.org.au/about-us/
about-the-garvan-institute/>, [accessed 14 October 2020].
56 Jeffrey Braithwaite and others, ‘Accomplishing Reform: Successful Case Studies Drawn from the Health Systems of
60 Countries’, International Journal for Quality in Health Care, 29.6, (2017), 880–886 (p. 883).
57 The University of Melbourne and Lendlease, Melbourne Connect: Creating a Connected Innovation Ecosystem in
the Heart of Melbourne Brochure, 2020, p. 2.
58 Mariana Mazzucato, The Entrepreneurial State, 2011, pp. 70–71.
59 Deloitte Center for Health Solutions, Top 10 Health Care Innovations: Achieving More for Less, 2016, p. 3; Singhal and
Carlton, p. 4.
60 Singhal and Carlton, p. 8.
61 Victorian Government, Healthier Lives, Stronger Economy: Victoria’s Health and Medical Research Strategy
2016–2020, 2016, pp. v–vii.
62 Government of South Australia, Department for Innovation and Skills, <innovationandskills.sa.gov.au/>, [accessed
6 October 2020].
63 RCVMHS, BCA Digital Fireside Chat—Roundtable: Record of Proceedings, 2020.
64 Black Dog Institute, Submission to the Productivity Commission Inquiry into Mental Health, 2019, p. 23.
65 RCVMHS, Innovation Roundtable: Record of Proceedings, 2020.
66 Witness Statement of Dr Hila Haskelberg, para. 76.

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67 Buenos Aires Times, Edmund Phelps: “It’s Important to Get a Debt Agreement That Is Feasible for Argentina”, <www.
batimes.com.ar/news/economy/edmund-phelps-its-important-to-get-a-debt-agreement-that-is-feasible-for-
argentina.phtml>, [accessed 6 October 2020].
68 Witness Statement of Associate Professor Jo-An Atkinson, para. 92; Witness Statement of Georgie Harman, 2020,
paras. 76 and 80.
69 Braithwaite and others, p. 883.
70 William D. Eggers and Mike Turley, The Future of Regulation: Principles for Regulating Emerging Technologies,
2018, pp. 9–10.
71 Eggers and Turley, p. 11.
72 RCVMHS, Innovation Roundtable: Record of Proceedings.
73 Witness Statement of Frank Quinlan, 25 May 2020, para. 39.
74 Witness Statement of Dr Hila Haskelberg, para. 79.
75 Witness Statement of Angus Clelland, para. 144.
76 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 393.
77 Translational Cancer Research Network, Translational Research—Defining the “T’s”, <www.tcrn.unsw.edu.au/
translational-research-definitions>, [accessed 6 October 2020].
78 Royal Commission into Victoria’s Mental Health System, Interim Report, pp. 392–394.
79 The Florey Institute of Neuroscience and Mental Health, Submission to the RCVMHS: SUB.0002.0029.0209, 2019, pp.
5–6; Dana-Farber Cancer Institute, Basic, Clinical and Translational Research: What’s the Difference?, <blog.dana-
farber.org/insight/2017/12/basic-clinical-translational-research-whats-difference/>, [accessed 6 October 2020].
80 RCVMHS, Innovation Roundtable: Record of Proceedings.
81 Witness Statement of Mary-Ann O’Loughlin AM, 28 July 2020, para. 58.
82 RCVMHS, Innovation Roundtable: Record of Proceedings.
83 Australian Evaluation Society, Talking About Evaluation, <aes.asn.au/talking-about-evaluation>, [accessed
12 October 2020].
84 Department of Treasury and Finance, Performance Management Framework: For Victorian Government
Departments March 2016, 2017, p. 32; Australian Psychological Society, Submission to the RCVMHS:
SUB.0002.0029.0349, 2019, p. 77.
85 Department of Treasury and Finance, Performance Management Framework: For Victorian Government
Departments March 2016, p. 37.
86 Department of Health and Human Services, Victorian Health Services Performance Monitoring Framework
2019–20, 2019, p. 28.
87 Catherine Althaus, Peter Bridgman and Glyn Davis, Chapter 11: Evaluation, in The Australian Policy Handbook:
A Practical Guide to the Policy-Making Process, 6th Edition (Allen and Unwin Academic, 2017), pp. 200–214 (p. 201).
88 Witness Statement of Professor David Castle, 29 May 2020, para. 62.
89 Althaus, Bridgman and Davis, p. 209.
90 Department of Treasury and Finance, Performance Management Framework: For Victorian Government
Departments March 2016, p. 32.
91 Mental Health Victoria and Mental Health Legal Centre, Submission to the RCVMHS: SUB.0002.0029.0006,
2019, p. 31; Mental Health Victoria and Victorian Healthcare Association, Submission to the RCVMHS:
SUB.0002.0029.0005, 2019, p. 55.
92 Witness Statement of Vrinda Edan, 10 July 2019, para. 33; Victorian Council of Social Service, Submission to the
RCVMHS: SUB.0002.0029.0282, 2019, p. 20.
93 Witness Statement of Robyn Kruk AO, 4 May 2020, para. 29.
94 Althaus, Bridgman and Davis, p. 212.
95 Productivity Commission, Mental Health Inquiry Report, Volume 3, p. 1239.
96 Productivity Commission, Mental Health Inquiry Report, Volume 3, p. 1236.
97 Productivity Commission, Mental Health Inquiry Report, Volume 3, p. 1236.
98 Productivity Commission, Mental Health Inquiry Report, Volume 3, p. 1237.
99 Productivity Commission, Mental Health Inquiry Report, Volume 3, pp. 1131 and 1234.
100 Productivity Commission, Mental Health Inquiry Report, Volume 3, p. 1123.
101 RCVMHS, Allied Health Workforce Human-Centred Design Focus Group: Record of Proceedings, 2020; RCVMHS,
Nurses Workforce Human-Centred Design Focus Group: Record of Proceedings, 2020; ORIMA Research, Mental
Health Workforce Survey, 2020, pp. 8, 24–28 and 67.
102 Bianca Albers, Mary Abdo and Robyn Mildon, Implementing the Commission’s Recommendations: Prepared by the
Centre for Evidence and Implementation for the Royal Commission into Victoria’s Mental Health System, 2020, pp. 7–8.

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103 Witness Statement of Professor Alexander McFarlane AO, 14 May 2020, para. 107.
104 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 393; Victorian Government, Healthier
Lives, Stronger Economy: Victoria’s Health and Medical Research Strategy 2016–2020, p. 5; Orygen, The National
Centre of Excellence in Youth Mental Health, Submission to the RCVMHS: SUB.2000.0001.0741, 2019, pp. 16 and 46;
The Florey Institute of Neuroscience and Mental Health, p. 4.
105 Royal Commission into Victoria’s Mental Health System, Interim Report, pp. 400, 407 and 411.
106 Public Health and Wellbeing Act 2008 (Vic) sec. 5; Department of Health and Human Services, Victorian Health Services
Performance Monitoring Framework 2019–20, p. 4; Witness Statement of Kym Peake, 2019, paras. 224.4 and 229.5.
107 18 per cent of Victoria’s start-up firms operating in 2020 are health-focused, indicating that entrepreneurial
interest is consolidating in the sector. LaunchVic, Victorian Start-up Ecosystem Mapping, 2020, p. 17.
108 Royal Commission into Victoria’s Mental Health System, Interim Report, p.403.
109 Alfred Health, Submission to the RCVMHS: SUB.0002.0028.0157, 2019, p. 17.
110 Witness Statement of Professor Robert Thomas OAM, 12 May 2020, para. 16.
111 Nev Jones, Louise Byrne and Sarah Carr, ‘If Not Now, When? COVID-19, Lived Experience, and a Moment for Real
Change’, The Lancet Psychiatry, 2020, 1–2 (p. 1); Witness Statement of Cath Roper, para. 17.
112 RCVMHS, Consumer Foundations Working Group, 14 August 2020: Record of Proceedings, 2020.
113 Witness Statement of Cath Roper, para. 42.
114 Witness Statement of Cath Roper, paras. 21 and 31.
115 Consumer Foundations Working Group, Correspondence to the RCVMHS: Consumer Leadership and Mobilisation,
2020, p. 25.
116 Witness Statement of Indigo Daya, 12 May 2020, para. 106.
117 Future Generation, Australia’s Mental Health Crisis: Why Private Funders Are Not Answering the Call, 2019, p. 13;
Witness Statement of Associate Professor Jo-An Atkinson, paras. 92–93.
118 Witness Statement of Associate Professor Jo-An Atkinson, para. 93.
119 RCVMHS, Innovation Roundtable: Record of Proceedings.
120 RCVMHS, Innovation Roundtable: Record of Proceedings.
121 Witness Statement of Professor Ian Hickie AM, para. 180.
122 Department of Human Services, Policy Framework: Clinical Academic Positions and Activity 2004–09, 2004, <www.
yumpu.com/en/document/read/9047501/policy-framework-clinical-academic-positions-and-activity-2004>,
[accessed 26 October 2020].
123 Orygen, The National Centre of Excellence in Youth Mental Health and Brown, p. 47.
124 Witness Statement of Professor Suresh Sundram, 19 May 2020, paras. 176–179.
125 Department of Human Services, p. 5; Dr Louise Byrne, Promoting Lived Experience Perspective: Discussion Paper
Prepared for the Queensland Mental Health Commission, p. 5.
126 Witness Statement of Matt Jones, 29 July 2020, para. 28; Witness Statement of Frank Quinlan, para. 39; Witness
Statement of Professor Graham Meadows, 26 June 2020, para. 84.
127 Association of Australian Medical Research Institutes, Submission to the Productivity Commission Inquiry into
Mental Health, 2019, p. 43.
128 Prevention United, Submission to the RCVMHS: SUB.0002.0028.0412, 2019, p. 11.
129 Orygen, The National Centre of Excellence in Youth Mental Health, p. 47; Monash Health, Submission to the
RCVMHS: SUB.7000.0003.0001, 2019, pp. 65–66.
130 Philip J Batterham and others, ‘NHMRC Funding of Mental Health Research’, Medical Journal of Australia, 205.8,
2016, 348–349, (p.348); Witness Statement of The Hon. Robert Knowles AO, 16 July 2019, para. 30.
131 Australian Institute of Health and Welfare, Mental Health Services in Australia: Expenditure on Mental Health
Services 2016–17, EXP.31; Australian Government Department of Health, Cancer Fact Sheet, 9 July 2018, <www1.
health.gov.au/internet/main/publishing.nsf/Content/A091E85A15E4F93DCA25814E0005C8EE/$File/20180709%20
Cancer%20Fact%20Sheet.pdf> [accessed 22 January 2021].
132 National Health and Medical Research Council, Research Funding Statistics and Data, <www.nhmrc.gov.au/
funding/data-research/research-funding-statistics-and-data>, [accessed 7 November 2019]; Productivity
Commission, Mental Health Inquiry Report, Volume 3, p. 1242.
133 Future Generation, p. 21.
134 Future Generation, p. 24.
135 Orygen, The National Centre of Excellence in Youth Mental Health, pp. 46–47.
136 The University of Melbourne, Submission to the RCVMHS: SUB.0002.0029.0263, 2019, p. 6; Witness Statement of Dr
Gerard Naughtin, 24 July 2019, para. 17; Mental Health Victoria and Victorian Healthcare Association, p. 5.

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137 Productivity Commission, Mental Health Inquiry Report, Volume 3, pp. 1242–1243; National Health and Medical
Research Council, Research Funding Statistics and Data, <www.nhmrc.gov.au/funding/data-research/research-
funding-statistics-and-data>, [accessed 7 November 2019].
138 Witness Statement of Professor Patrick McGorry AO, 2 July 2019, paras. 15 and 34; The University of Melbourne, p. 6;
Orygen, The National Centre of Excellence in Youth Mental Health, pp. 46–47.
139 Evidence of Professor Patrick McGorry AO, 5 July 2019, pp. 333–334.
140 Brianna Jade Chesser, Criminal Courts and Mental Illness: The Emergence of Specialist Problem Solving Courts in
Australia (Thomson Reuters (Professional) Australia Limited, 2016), pp. 25–26.
141 Professor Arthur Christopoulos, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University,
Correspondence to the RCVMHS: CSP.0001.0131.0001, 2020.
142 Evidence of Professor Patrick McGorry AO, p. 334.
143 St Vincent’s Hospital Melbourne, Submission to the RCVMHS: SUB.0002.0030.0106, 2019, p. 18; Joseph Firth and
others, ‘The Lancet Psychiatry Commission: A Blueprint for Protecting Physical Health in People with Mental Illness’,
The Lancet Psychiatry, 6 (2019), 675–712 (p. 685).
144 Witness Statement of Dr Neil Coventry, 29 July 2020, para. 363(e).
145 Mental Health Complaints Commissioner, Submission to the RCVMHS: SUB.4000.0001.0179, 2019, p. 25.
146 Mental Health Complaints Commissioner, p. 34.
147 Mental Health Complaints Commissioner, pp. 17 and 64; Lisa Brophy and others, People Making Choices: The Support
Needs and Preferences of People with Psychosocial Disability (Mind, 2014), p. 29; Firth and others, pp. 1 and 12–13.
148 Dr Stuart Thomas, Kaisha Corkery-Lavender, Dr Michael Daffern and Dr Danny Sullivan, Centre for Forensic
Behavioural Science, School of Psychology & Psychiatry, Monash University, Disability, Mental Health and
Medication: Implications for Practice and Policy, 2010, p. 7.
149 Mental Health Complaints Commissioner, p. 49.
150 Association of Counselling Psychologists, Submission to the Productivity Commission Inquiry into Mental Health,
2019, p. 6.
151 Andrea Cipriani and others, ‘Comparative Efficacy and Acceptability of 21 Antidepressant Drugs for the Acute
Treatment of Adults with Major Depressive Disorder: A Systematic Review and Network Meta-Analysis’, The Lancet,
391, 2018, 1357–1366 (p. 1358).
152 John Ioannidis, ‘Effectiveness of Antidepressants: An Evidence Myth Constructed from a Thousand Randomized
Trials?’, Philosophy, Ethics, and Humanities in Medicine, 3:14, 2008, 1–9 (p. 1).
153 Pat Bracken and others, ‘Psychiatry beyond the Current Paradigm’, British Journal of Psychiatry, 201.6, (2012),
430–434 (p. 432).
154 Paul J Harrison, ‘Recent Genetic Findings in Schizophrenia and Their Therapeutic Relevance’, Journal of
Psychopharmacology, 29.2, (2015), 85–96 (p. 92).
155 Productivity Commission, Mental Health Inquiry Report, Volume 1, 2020, p. 38.
156 Centre for Mental Health, Swinburne University of Technology, Submission to the RCVMHS: SUB.0002.0030.0009,
2019, p. 5; The Florey Institute of Neuroscience and Mental Health, p. 5.
157 The Florey Institute of Neuroscience and Mental Health, p. 5.
158 Witness Statement of Professor Shitij Kapur, 8 May 2020, para. 50.
159 Productivity Commission, Mental Health Inquiry Report, Volume 3, pp. 1242–1243.
160 Royal Commission into Victoria’s Mental Health System, Interim Report, p.476; Evidence of Dr Graham Gee, 16
July 2019, p. 1120; NorthWestern Mental Health (A Division of Melbourne Health), Submission to the RCVMHS:
SUB.0002.0030.0061, 2019, p. 6.
161 Productivity Commission, Mental Health Inquiry Report, Volume 3, p. 1233.
162 Australian Psychological Society, pp. 76–77.
163 Foundation House, Submission to the RCVMHS: SUB.1000.0001.0868, 2019, p. 39.
164 Witness Statement of Matt Jones, para. 28; Witness Statement of Frank Quinlan, para. 39; Witness Statement of
Professor Graham Meadows, para. 84.
165 Witness Statement of Honor Eastly, 14 September 2020, para. 63b.
166 RCVMHS, Innovation Roundtable: Record of Proceedings.
167 Witness Statement of Graham Panther, 6 July 2020, paras. 170–171.
168 Witness Statement of Dr Hila Haskelberg, para. 77.
169 Witness Statement of Georgie Harman, 2020, para. 80.
170 RCVMHS, Innovation Roundtable: Record of Proceedings.
171 Witness Statement of Professor Lisa Brophy, 29 April 2020, para. 35.
172 RCVMHS, Innovation Roundtable: Record of Proceedings; Witness Statement of Alan Woodward, 18 July 2019, para. 39.

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173 RCVMHS, Innovation Roundtable: Record of Proceedings.

174 Black Dog Institute, Submission to the Productivity Commission Inquiry into Mental Health, p. 24.
175 Witness Statement of Alan Woodward, para. 39.
176 Witness Statement of Georgie Harman, 2020, para. 79.
177 Zoë Slote Morris, Steven Wooding and Jonathan Grant, ‘The Answer Is 17 Years, What Is the Question:
Understanding Time Lags in Translational Research’, Journal of the Royal Society of Medicine, 104.12 (2011), 510–520
(p. 510); The Florey Institute of Neuroscience and Mental Health, p. 5.
178 Witness Statement of Professor Mario Alvarez-Jimenez, para. 96.
179 The Florey Institute of Neuroscience and Mental Health, p. 5.
180 RCVMHS, Innovation Roundtable: Record of Proceedings.
181 Black Dog Institute, Submission to the Productivity Commission Inquiry into Mental Health, p. 23.
182 Witness Statement of Kym Peake, 4 October 2020, para. 279.
183 Witness Statement of Georgie Harman, 2020, para. 21.
184 Black Dog Institute, Submission in Response to the Draft Report from the Productivity Commission Inquiry into
Mental Health, 2020, p. 2.
185 Witness Statement of Dr Hila Haskelberg, para. 101.
186 Witness Statement of Dr Hila Haskelberg, para. 101.
187 Witness Statement of Kym Peake, 2020, para. 282.
188 Witness Statement of Graham Panther, para. 9.
189 Witness Statement of Professor Shitij Kapur, para. 60.
190 Witness Statement of Professor Shitij Kapur, para. 61.
191 Victorian Government, Submission to the RCVMHS: SUB.5000.0001.0001, 2019, p. 35.
192 LaunchVic, State of HealthTec Victoria, pp. 25–26.
193 RCVMHS, Innovation Roundtable: Record of Proceedings.
194 Witness Statement of Kym Peake, 2019, paras. 86–89; Council on the Ageing, Submission to the RCVMHS:
SUB.1000.0001.0789, 2019, p. 20; Mind Australia, Submission to the RCVMHS: SUB.0010.0029.0372, 2019, p. 48;
Perinatal Anxiety and Depression Australia, Submission to the RCVMHS: SUB.0002.0030.0055, 2019, p. 27.
195 Witness Statement of Kym Peake, 2019, paras. 86–87.
196 Witness Statement of Professor Patrick McGorry AO, 2019, para. 14.
197 Witness Statement of Dr Tim Moore, 2 June 2020, para. 62.
198 Future Generation, p. 13.
199 RCVMHS, Allied Health Workforce Human-Centred Design Focus Group: Record of Proceedings.
200 Department of Health and Human Services, Mental Health Research and Knowledge Translation Plan: Discussion
Paper, 2017, pp. 12–14.
201 Witness Statement of Dr Shaymaa Elkadi, 25 May 2020, para. 48.
202 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 394.
203 Productivity Commission, Mental Health Inquiry Report, Volume 3, pp. 1189–1190.
204 Productivity Commission, Mental Health Inquiry Report, Volume 3, p. 1233.
205 Centre for Evaluation and Research, Department of Health and Human Services, Evaluation Guide, 2017.
206 Victorian Auditor-General’s Office, p. 34.
207 Department of Health and Human Services, Chief Psychiatrist Guideline and Practice Resource: Family Violence,
2018; Cherrie Galletly and others, ‘Royal Australian and New Zealand College of Psychiatrists Clinical Practice
Guidelines for the Management of Schizophrenia and Related Disorders’, Australian and New Zealand Journal of
Psychiatry, 50.5 (2016), 1–117; Gin S Malhi and others, ‘Royal Australian and New Zealand College of Psychiatrists
Clinical Practice Guidelines for Mood Disorders’, Australian & New Zealand Journal of Psychiatry, 49.12 (2015),
1087–1206; Jasmin Grigg and others, Methamphetamine Treatment Guidelines: Practice Guidelines for Health
Professionals (Second Edition), 2018; The Bouverie Centre, Guidelines for Trauma-Informed Family Sensitive
Practice in Adult Health Services, 2013; Safer Care Victoria, Caring for People Displaying Acute Behavioural
Disturbance: Clinical Guidance to Improve Care in Emergency Settings–Draft for Consultation, 2020; The Australian
College of Mental Health Nurses, Mental Health Practice Standards for Nurses in Australian General Practice, 2018.
208 RCVMHS, Innovation Roundtable: Record of Proceedings.
209 Victorian Government, Submission to the RCVMHS: SUB.5000.0001.0001, p. 22.
210 Prevention Coalition in Mental Health, Primed for Prevention: A Consensus Statement on the Prevention of Mental
Disorders, 2020, p. 23.
211 RCVMHS, Mentally Healthy Workplaces Roundtable: Record of Proceedings, 2020.

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212 Alfred Health, p. 23.

213 Alfred Health, p. 23.
214 Evidence of Dr Ravi Bhat, pp. 989–990.
215 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 391.
216 Melbourne Children’s Campus, Submission to the RCVMHS: SUB.0002.0030.0152, 2019, p. 2.
217 Murdoch Children’s Research Institute, Creating a System of Care for Child Mental Health, <www.mcri.edu.au/users/
mcri-administrator/blog/creating-system-care-child-mental-health-0>, [accessed 24 November 2020].
218 Department of Education and Training, Help Develop Mental Health Support and Resources for Primary Schools,
<www.education.vic.gov.au/school/teachers/classrooms/Pages/approachesmentalhealthsupportprimary2020.
aspx>, [accessed 24 November 2020].
219 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 400.
220 Orygen, The National Centre of Excellence in Youth Mental Health, p. 9.
221 Orygen, Annual Report 2018–19, 2019, p. 74.
222 Orygen, p. 75.
223 Orygen, p. 9; International Association for Youth Mental Health, The 5th International Conference on Youth Mental
Health; United for Global Change,<www.iaymh2019.com/>, [accessed 11 January 2021].
224 Orygen, pp. 8 and 60.
225 Orygen, Annual Report 2018–19, 2019, p. 13.
226 Orygen, Orygen Welcomes Victorian Government’s COVID-19 Mental Health Support Package, <orygen.org.au/
About/News-And-Events/2020/Orygen-welcomes-Victorian-Government%E2%80%99s-COVID-19-me>, [accessed
26 October 2020].
227 Orygen, $33 Million Grant for Psychosis Research Sets Australian Record for Medical Research Funding, <www.
orygen.org.au/About/News-And-Events/2020/$33-million-grant-for-psychosis-research-sets-Aust>, [accessed 24
November 2020].
228 Witness Statement of Professor Suresh Sundram, para. 179; Witness Statement of Professor Emeritus Bruce Singh
AM, para. 70.
229 Witness Statement of Professor Suresh Sundram, para. 157.
230 Witness Statement of Professor Suresh Sundram, para. 158.
231 Orygen, The National Centre of Excellence in Youth Mental Health, p. 47.
232 Debbie Carrick-Sen, Alison Richardson, Anne Moore and Shelley Dolan, Transforming Healthcare through Clinical
Academic Roles in Nursing, Midwifery and Allied Health Professions: A Practical Resource for Healthcare Provider
Organisations (The Association of UK University Hospitals, 2016), p. 9.
233 Department of Human Services, p. 2.
234 Witness Statement of Professor Emeritus Bruce Singh AM, 23 July 2020, para. 14.
235 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 401.
236 Productivity Commission, Mental Health Inquiry Report, Volume 3, pp. 1131 and 1234.
237 Better Care Victoria, Better Care Victoria Innovation Fund, <www.bettercare.vic.gov.au/our-work/innovation-fund>,
[accessed 6 October 2020].
238 Witness Statement of Honor Eastly, para. 63(c).
239 Monash Sustainable Development Institute, p. 19.
240 LaunchVic, About LauncVic.
241 LaunchVic, Annual Report 2018–19, 2019, p. 5.
242 Eggers and Turley, p. 11.
243 Harvard Business Review, How the Japanese Government’s New “Sandbox” Program Is Testing Innovations in
Mobility and Technology, <hbr.org/sponsored/2020/02/how-the-japanese-governments-new-sandbox-program-is-
testing-innovations-in-mobility-and-technology>, [accessed 6 October 2020].
244 Alfred Health, p. 24.
245 Victorian Agency for Health Information and Safer Care Victoria, Media Release: Partnering with IHI to Deliver
the Victorian Patient Safety Program, 24 September 2018, <www.bettersafercare.vic.gov.au/news-and-media/
partnering-with-ihi-to-deliver-the-victorian-patient-safety-program>, [accessed 31 August 2020].
246 Department of Health and Wellbeing, South Australia, Mental Health Services Plan 2020–2025, 2019, p. 15.
247 health.vic, Evidence and Evaluation, <www2.health.vic.gov.au/public-health/population-health-systems/evidence-
and-evaluation>, [accessed 6 October 2020].
248 health.vic, Evidence and Evaluation.
249 Mental Health Victoria and Mental Health Legal Centre, Submission to the RCVMHS: SUB.0002.0029.0006, p. 18.

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250 Witness Statement of Alan Woodward, para. 39.

251 Austin Health, Submission to the RCVMHS: SUB.0003.0001.0001, 2019, p. 5.
252 Mental Health Act 2014 (Vic), sec. 118(1)(e).
253 Productivity Commission, Mental Health Inquiry Report, Volume 3, p. 1129.
254 Witness Statement of Professor Helen Herrman AO, 1 July 2019, p. 193.
255 Witness Statement of Dr Ravi Bhat, 4 July 2019, paras. 73–75.
256 The Royal Australian and New Zealand College of Psychiatrists, Submission to the RCVMHS: SUB.0002.0029.0227,
2019, p. 15.
257 Productivity Commission, Mental Health Inquiry Report, Volume 3, pp. 1118–1119.
258 Productivity Commission, Mental Health Inquiry Report, Volume 3, p. 1234.
259 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 406.
260 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 56.
261 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 51.
262 Witness Statement of Professor Neil Rees, 15 June 2020, paras. 56 and 75; Foundation House, Submission to the
RCVMHS: SUB.1000.0001.0868, p. 39; Witness Statement of Associate Professor Simon Stafrace, 2020, para. 95.
263 MacKillop Family Services, Submission to the RCVMHS: SUB.0002.0029.0174, 2019, p. 17; Evidence of Professor Louise
Newman AM, 23 June 2020, p. 20; Evidence of Professor David Coghill, 23 June 2020, pp. 55–56; Jenny Welsh, Laura
Ford, Lyndall Strazdins and Sharon Friel, Evidence Review: Addressing the Social Determinants of Inequities in
Mental Wellbeing of Children and Adolescents, 2015, pp. 35–36; Paola Pedrelli, Ben Shapero, A Archibald and Chelsea
Dale, ‘Alcohol Use and Depression During Adolescence and Young Adulthood: A Summary and Interpretation of Mixed
Findings’, Current Addiction Reports, 3.1, 2016, 91–97 (p. 96); Yasmin L. Hurd and others, ‘Cannabis and the Developing
Brain: Insights into Its Long-Lasting Effects’, The Journal of Neuroscience, 39.42, (2019), 8250–8258 (p. 8258).
264 Witness Statement of Dr Piers Gooding, 25 June 2020, paras. 32(d) and 32(f); Witness Statement of Professor Mario
Alvarez-Jimenez, paras. 31, 33 and 180; Witness Statement of Associate Professor Simon Stafrace, 2020, paras.
190 and 199.
265 National Mental Health Commission, Contributing Lives, Thriving Communities: Report of the National Review
of Mental Health Programmes and Services, Volume 2: Every Service Is a Gateway Response to Terms of
Reference, 2014, p. 138; Victorian Aboriginal Children and Young People’s Alliance, Submission to the RCVMHS:
SUB.0002.0028.0546, 2019, p. 13; Witness Statement of Andrew Jackomos PSM, 11 July 2019, para. 97; Witness
Statement of Andrew Jackomos PSM, 6 July 2019, para. 97 and p. 325; Pat Swan, Professor Beverley Raphael, and
National Aboriginal Community Controlled Health Organization, Ways Forward: National Aboriginal and Torres
Strait Islander Mental Health Policy: National Consultancy Report, 1995, p. 38.
266 Centre for Multicultural Youth, Submission to the RCVMHS: SUB.0002.0032.0067, 2019, pp. 6–7; Multicultural Centre
for Women’s Health, Submission to the RCVMHS: SUB.0002.0030.0303, 2019, pp. 9–10.
267 Department of Premier and Cabinet, Discussion Paper for the Victorian LGBTIQ Strategy, 2020, pp. 13–14; RCVMHS,
LGBTI Roundtable: Record of Proceedings, 2019.
268 Mental Health Victoria and Council on the Ageing, Correspondence to the RCVMHS: CSP.0001.0101.0001, Priorities
to support the mental health of older Victorians, 2020, p. 19; National Ageing Research Institute, Submission to the
RCVMHS: SUB.0002.0024.0049, 2019, pp. 2 and 6.
269 Evidence of Professor Patrick McGorry AO, p. 334; Patrick McGorry and others, ‘“Is ‘Early Intervention’ in Bipolar
Disorder What It Claims to Be?” Malhi et al’, Bipolar Disorders, 20.3 (2018), 181–183 (p. 182); Harrison, p. 92.
270 Witness Statement of Professor Lisa Brophy, para. 75; Witness Statement of Professor Penelope Weller, 27 August
2020, para. 30; Witness Statement of Professor David Castle, para. 72; Witness Statement of Professor David Copolov
AO, 7 July 2020, paras. 253 and 273; Graham Thornicroft and others, ‘Evidence for Effective Interventions to Reduce
Mental-Health-Related Stigma and Discrimination’, The Lancet, 387 (2016), 1123–1132 (p. 1129); Amy J. Morgan and others,
‘Interventions to Reduce Stigma towards People with Severe Mental Illness: Systematic Review and Meta-Analysis’,
Journal of Psychiatric Research, 103 (2018), 120–133 (pp. 130–131); Nisha Mehta and others, ‘Evidence for Effective
Interventions to Reduce Mental Health-Related Stigma and Discrimination in the Medium and Long Term: Systematic
Review’, British Journal of Psychiatry, 207.5 (2015), 377–384 (p. 383); Claire Henderson and others, ‘Mental Health-Related
Stigma in Health Care and Mental Health-Care Settings’, The Lancet Psychiatry, 1 (2014), 467–482 (p. 479); Bruce G. Link
and Jo C. Phelan, ‘Conceptualizing Stigma’, Annual Review of Sociology, 27 (2001), 363–385 (pp. 365 and 382).
271 Witness Statement of Professor Jane Pirkis, 18 July 2019, para. 28; Evidence of Professor Jane Pirkis, 22 July 2019,
p. 1469; Department of Health and Human Services, Victorian Suicide Prevention Framework 2016–25, 2016, p. 24;
Orygen, The National Centre of Excellence in Youth Mental Health, p. 42; Jo Robinson and others, ‘What Works in
Youth Suicide Prevention? A Systematic Review and Meta-Analysis’, EClinicalMedicine, 4–5, (2018), 52–91 (pp. 52–91);
Sarah Coker and others, Better Support: Understanding the Needs of Family and Friends When a Loved One
Attempts Suicide, 2019, p. 4.
272 Witness Statement of Professor Alexander McFarlane AO, paras. 20, 79 and 101; Foundation House, Integrated
Trauma Recovery Service Model, 2016, pp. 8–9.

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273 Witness Statement of Professor Patrick McGorry AO, 2019, para. 11; Witness Statement of Professor Lisa Brophy,
para. 97; David Castle and others, Submission to the RCVMHS: SUB.0002.0002.0118, 2019, p. 3; National Institute
for Health and Care Excellence, United Kingdom, Rehabilitation for Adults with Complex Psychosis (NG181):
NICE Guideline, 2020, pp. 46–49; Carol Harvey and others, Models of Care for Victorians Living with Severe and
Persistent Mental Illness and Complex Multiagency Needs: Literature Review and Key Reform Considerations.
Report Prepared for the Royal Commission into Victoria’s Mental Health System by the University of Melbourne,
2020, p. 6; E Sally Rogers, ‘Recovery-Oriented Practices Need Innovative Research’, The Lancet Psychiatry, 6.2,
(2019), 82–83 (p. 82).

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Chapter 37

Implementation

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37.1  The work ahead

The Royal Commission has reached its end, delivering 74 recommendations spanning
two reports.

During the two years of its operation, the Commission engaged widely with the community,
collected a wealth of knowledge and evidence and undertook a comprehensive systems
design process to set the reform agenda. Collectively, the recommendations contained in this
report present the Commission’s aspirations for a reimagined and compassionate mental
health and wellbeing system.

While much has already been done, and the foundations for reform are set, considerable
work lies ahead to realise the Commission’s ambitions. Promisingly, the Commission has
observed an encouraging level of public discourse, community‑wide interest and open
communication about mental health and wellbeing. The Commission’s inquiry benefited
enormously from this collective momentum, which must now be harnessed to support
implementation efforts.

The recommendations made in the Commission’s interim report are currently being
implemented. Those reforms focused on responding to pressing challenges within the system
and preparing for the extensive changes to come.1 This report puts forward the Commission’s
final directions on how to transform the mental health system so that all Victorians ‘can
experience their best mental health, now and into the future’.2

Although this report is a major milestone, it is only the start of the reform process. The
Commission has created a plan of action—however, ‘a strategy is only as good as its
execution’.3 Putting the Commission’s ambitious reform agenda into practice is what will
make the hopes held by many in the Victorian community become a reality. Implementation
is not about repeating the work of the Commission or revisiting its decisions; it is about taking
definitive action and fulfilling the solutions presented in this report.4

If history is any indication, reform will not be easy. Despite best endeavours, previous efforts
to redesign the mental health system in Victoria, and across Australia more broadly, have not
been realised.5 As a result, the state’s mental health system has catastrophically failed to live
up to expectations and is unprepared for current and future challenges.6 This persistent gap
between the rhetoric of past inquiries and the reality for people living with mental illness or
psychological distress, families, carers and supporters as well as the mental health workforce,
has been described by some as devastating.7

The Victorian Mental Illness Awareness Council articulated its hopes that implementation of
the Commission’s recommendations will be different:

There is a history of reviews and inquiries making recommendations about reform of

the mental health sector with little follow through and the reforms come to nothing. This
would be tragic given the amount of work that has gone into the Royal Commission.8

The Commission agrees with this sentiment—that this time, the results must lead to
transformational change.

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Implementation, however, is rarely a straightforward activity. Many service systems, not just
mental health systems, have faced challenges in implementing inquiry recommendations.9
Evidence from past reviews suggests that a substantial number of recommended actions
or programs are never implemented.10 The factors that hamper implementation efforts are
complex, but failures in implementation may be attributed in part to a lack of preparedness,
loss of momentum due to changes in leadership, shifting policy agendas or insufficient
funding, people and expertise.11

Reforming Victoria’s mental health system brings its own unique challenges. One factor
contributing to this is the lack of priority given to the mental health system over the years,
partly fuelled by stigma and discrimination.12 The system’s many intersections with other
health, justice and social supports services, including, for example, physical health, alcohol
and other drug services and housing, is another. Now, the COVID‑19 pandemic and its
far‑reaching impacts have combined with these historical factors, further affecting the
process of reform.

Despite this, it is imperative to get implementation right. Witnesses Mary Corbett and her
brother and carer Jacob Corbett expressed what this would look like for them:

change that comes as result of the Royal Commission needs to be felt mainly at the
patient/consumer level—the level where people enter the mental health system and are
treated and discharged. There is no point doing a good analysis and good report, if it
does not effect change at the ground level; it becomes only a bureaucratic shuffle.13

Delivering on these aspirations requires strong leadership across the Victorian Government,
the workforce, service providers and, importantly, from people with lived experience of mental
illness or psychological distress, families, carers and supporters. Leaders must be equipped
with the knowledge, skills and attributes—with their development supported—to lead and
push change forward. Those already working in the system must be supported to engage
with and enable the reform process. Deliberate and sustained collaboration from all levels
of government, related systems and the Victorian community is also required. While there is
much at stake, all those involved in implementing the Commission’s recommendations must
rise to the challenge and work together to build a new mental health and wellbeing system.

There will be obstacles along the way. Ensuring all partners in delivering this reform
remain connected and committed to the change process will be imperative to success.
The Commission has presented a clear and compelling vision for profound change that
incorporates ways of maintaining these connections.

Implementing the reforms effectively will also require learning from past experiences,
including identifying and preventing unintended consequences and developing new ways of
thinking and doing. Some research encourages learning from the past as a means to prepare
for effective change in the future:

The incremental, incomplete and inconsistent approach to mental health reform over
the past twenty years is demonstrably inadequate and unaffordable for the challenges
now confronting our nation.

We can and must do better. To do better we have to accept the baggage from the
past, identify the barriers to reform and map out strategies for change based on these
experiences and those from overseas.14

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Establishing the foundational structures that will promote and enable large‑scale change
will not be a straightforward or sequential process; it will be dynamic and evolving, with many
reforms occurring in parallel. The Victorian Government will need to actively manage this
process, helping implementers to stay the course.

In announcing this inquiry, the current Victorian Government committed to implementing

every recommendation made by the Commission.15 The significance of this opportunity is not
lost on the Commission.

To achieve substantial policy change, royal commissions may need to adopt effective
‘influencing strategies’, involving problem framing, coalition building, and making
recommendations that are implementable.16 In this respect, the Commission has sought to
frame the narrative around the challenges facing the mental health system, made efforts
to strengthen the consensus for change and tested ideas for reform and implementation
with a wide range of actors. In line with its letters patent, it has also endeavoured to make
recommendations ‘to achieve practical, prioritised, efficient and sustainable outcomes’17 to
improve the lives of people living with mental illness or psychological distress, families, carers
and supporters.

In its recommendations, the Commission has expressed its hopes for a reimagined
mental health and wellbeing system and suggested how to implement reforms to achieve
these aspirations. This chapter takes a broad view. It aims to help prepare the Victorian
Government and all partners involved in implementation for success by exploring the
requirements needed for enduring and profound change across Victoria’s mental health
system—as well as potential pitfalls. This chapter therefore complements the Commission’s
recommendations and chapters in both its interim and final reports, and should be read
alongside them.

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37.2  Requirements for

transforming the system
In preparing to implement the Commission’s recommendations, it is essential to appreciate
the scale of the task at hand. The changes envisaged in this report are enormous. Not only
will successful reform require a great deal of investment, it will also rely on the establishment
of trust between all implementation partners18 involved in the reform process. All partners will
need to work together to follow the clear vision the Commission has set and stay focused on
implementing the recommendations.

The Commission acknowledges this will be challenging in a highly complex reform

environment. There are several major forces shaping Victoria’s future that will no doubt
influence implementation. Population and demographic changes, rising inequality and
social isolation and large‑scale disruptions—such as the severe bushfires and the COVID‑19
pandemic experienced during the Commission’s inquiry—will all have an impact. Chapter 1:
The reform landscape, explains what these issues mean for the Commission’s reform agenda
and presents critical features that are essential to the reform process: re‑established
confidence through prioritisation and collaboration; a responsive and integrated system
with community at its heart; contemporary and adaptable services; and a system attuned to
promoting inclusion and addressing inequities.

How to deliver the reimagined mental health and wellbeing system is a fundamental
consideration. Informed by evidence collected throughout the course of its inquiry, the
Commission has chosen to share its reflections on several key requirements for successful
implementation, with a view to assisting with implementation efforts. These reflections are
outlined below.

37.2.1  A clear and shared vision

The Commission has presented a compelling vision for a new mental health and wellbeing
system. It is a system that will deliver the best outcomes and experiences for individuals
and communities through an elevated focus on the prevention of mental illness and the
promotion of good mental health and wellbeing. It is a system that provides treatment, care
and support in the community, close to people’s homes and in line with their needs and
preferences.

The Commission has set out the structure of its report to cover the essential features of a
reformed mental health and wellbeing system:

• Volume 1 sets out the Commission’s vision for a responsive and integrated system that
centres on a community‑based model of care that provides people with dependable
access to services when and where it would make the most difference to them.

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• Volume 2 sets an expectation of collaboration in the future system supporting good

mental health and wellbeing in the settings in which people live, learn and work, with
improved treatment, care and support for Victorians of all ages, as well as collaborative
responses to: support people who have experienced trauma; increase access to safe
and secure housing; and improve suicide prevention and responses.
• Volume 3 recognises that the attainment of good mental health and wellbeing among
Victoria’s diverse communities requires responses that extend beyond purely the
mental health and wellbeing system to other supports that address inequities and
promote inclusion.
• Volume 4 creates new structures for enduring reform to support a contemporary
and adaptive system that provides high‑quality and safe services, including a new
approach to leadership, system governance and oversight.
• Volume 5 provides advice regarding the collection and distribution of expertise to
support continuous improvement and implementation efforts across Victoria's mental
health and wellbeing system, as well as an overview of the Commission's work to assist
future royal commissions.

The Commission’s reform approach is not about making isolated improvements. It seeks
to build a new system to meet the evolving needs and expectations of individuals and
communities now and into the future. Delivering this transformational change requires that
all recommendations established in this report are read collectively. Implementers must take
a long and broad view to understand how all the components of the redesigned system fit
together and reinforce each other.

The momentum for change generated by this report, and the reforms to come, will be
substantial. But this ambition relies on the continued prioritisation of good mental health and
wellbeing. In particular, it depends on a future in which good mental health and wellbeing is
rightly recognised as a fundamental tenet of a well‑functioning and compassionate society.

At the time of finalising this report, there is an encouraging level of support across the
Victorian and Commonwealth governments for change. The Commission recognises, however,
that changes to government leadership, competing priorities and a reluctance to commit to
long‑term reform are all potential barriers to the enduring success of its agenda.19

As explored throughout this report, mental health has been a low priority of successive
governments and the community.

Community attitudes towards people living with mental illness or psychological distress
have influenced funding decisions, detracting from investment in mental health.20 This lack
of prioritisation may have also been influenced by competing advocacy priorities, making
it difficult for governments to work out where the priority for reform lies and diminishing
accountability.21 As Professor Bruce Bonyhady AM, Executive Chair of the Melbourne Disability
Institute at the University of Melbourne, stated in a personal capacity:

Based on my own observation, the mental health sector has been deeply divided along
clinical mental health and community mental health lines. There has been conflict
and envy between these groups regarding who should receive funding—and at times
this has led them to undermine each other’s claims and this has made it easy for
governments to ignore both.22

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Ensuring mental health is a priority, and that there is a shared and clear vision for the future
at all levels of government decision making, will be critical to successfully implementing
the Commission’s recommendations. This will be particularly important in light of the many
reviews and planned reforms that are underway across comparable systems such as the
aged care and disability sectors. Maintaining a genuine commitment at the highest political
spheres at the local, state and national levels will be integral to achieving long‑lasting and
successful reform. As discussed in Chapter 29: Encouraging partnerships, governance
arrangements between the Commonwealth and state governments have recently evolved,
with decision making now occurring through the newly established National Cabinet Reform
Committee. These new arrangements have the advantage of streamlining decision making,23
yet the Commission holds concerns that these structures may limit the influence of the
Victorian Government and indeed other states and territories in progressing an ambitious
mental health and wellbeing agenda. It will therefore be vital that the Victorian Government
works closely with the Commonwealth Government and the National Cabinet Reform
Committee to ensure mental health and wellbeing remains a priority.

A bipartisan commitment to implementing the Commission’s recommendations will also be

important for implementation.24 Ms Georgie Harman, CEO of Beyond Blue, said that without
a bipartisan commitment, people will continue to miss out on the treatment, care and
support they deserve, ‘[w]ithout concerted, long‑term and bipartisan action—and addressing
broader social determinants and equity—people with the greatest needs will continue to
miss out.’25

Associate Professor Ruth Vine, then Executive Director of NorthWestern Mental Health,

Melbourne Health at the time of giving evidence, noted the importance of a bipartisan
approach in overcoming the current system’s challenges:

Mental health used to be deemed to be ‘above politics’ but it seems to have become
increasingly politicised with successive governments wanting to make their mark.
This is not good for system development, the clinical workforce and the end users. The
government must be bipartisan in relation to mental health as it was in the 1990s and
has to be for many years, as the challenges in the system cannot be overcome in a single
term of government or by switching between partisan policies.26

In some ways, the COVID‑19 pandemic has strengthened collaborative approaches to reform,
demonstrating the value of bipartisanship between levels of government. The Commission
hopes these efforts continue and that they may sustain momentum for reform as the mental
health system is reshaped. The Hon. Julia Gillard AC, Chair of Beyond Blue, noted the benefits
of bipartisanship during times of significant change, ‘[t]he collaborative, bipartisan response
to the mental health challenges posed by this crisis has been swift and decisive and reminds
us of what we can achieve by working together.’27

Professor Rob Moodie, Deputy Head of School and Professor of Public Health at the University
of Melbourne, shared similar thoughts:

If you can forge bipartisanship, then you can generally forge more effective
interventions. Those interventions are the responsibility of government. For example,
in the case of COVID‑19, we have seen significant bipartisan interventions around
controlling COVID‑19 and stimulating the economy.28

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The attitudes and perceptions of the community also play an important role, given ‘the public
hold[s] the key to transformational change’.29

When there is strong community support for recommendations, this can help overcome
objections in other sections of the community and give government ‘licence’ to implement
difficult changes.30 This has been demonstrated with successful reforms in the past. For
example, while Medicare was originally met with mixed reviews, those opposed to its
introduction were persuaded in part by strong community support for universal access to
health care.31

Professor David Copolov AO, Professor of Psychiatry and Pro Vice Chancellor of Major
Campuses and Student Engagement at Monash University, shared similar observations,
reflecting on lessons from the National Disability Insurance Scheme:

In particular, the early history of the [National Disability Insurance Scheme] teaches us
that we need … recognition that we cannot expect politicians to support reforms unless
there is already clear, visible and unified community support ...32

There is such evidence of strong community support for the types of changes the
Commission is recommending. There is certainly much more public conversation about and
interest in mental health and wellbeing. The work of this Commission, alongside national
efforts for reform—including the Productivity Commission’s Mental Health Inquiry Report
and the work of the Prime Minister’s Suicide Prevention Adviser—have contributed to this.
This heightened level of community awareness presents a unique opportunity that must be
capitalised on to achieve momentum in implementation.

The community’s interest in and connection to reform will also shore up continued efforts to
raise awareness of mental health and wellbeing and to tackle the stigma and discrimination
associated with poor mental health and mental illness, and should therefore be harnessed.
Indeed, those implementing the reforms must bring the Victorian community with them.
Being clear about the broad vision and principles underpinning reform, and ensuring they
resonate with the public, will help with this.33 As Ms Kym Peake, the former Secretary of the
then Department of Health and Human Services, said:

it is important to inspire a commitment to reform by presenting a compelling vision

for the future and anchoring change back to the values that matter for the sector. This
vision and an agreement on the direction for change can encourage buy in, help focus
collective efforts and keep people engaged in the face of challenges and set‑backs.34

As a starting point, implementers should draw inspiration from the Commission’s guiding
principles (refer to Figure 37.1), which outline the Commission’s aspirations for a reformed
mental health and wellbeing system. They should build on these principles to convey to the
public the vision and direction for the change ahead in an open and clear way. Implementers
also need to offer the public opportunities to genuinely engage and participate in reform.

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Figure 37.1:  The Commission’s guiding principles for a future mental health and wellbeing system

Note: These principles are in large part based on the many contributions made to the Commission, as well as relevant
international documents such as the United Nations’ Convention on the Rights of Persons with Disabilities, the
World Health Organization’s publications on mental health (including its 2014 report with the Calouste Gulbenkian
Foundation on the social determinants of mental health) and legislation such as the Commonwealth Government’s
Carers Recognition Act 2010.

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37.2.2  The importance of leadership

The Parenting Research Centre pointed out that the more complex the reform process, the
more important leadership is.35 Therefore, leadership across all aspects of Victoria’s mental
health and wellbeing system will be critical in implementing change. It will also be vital that
all those delivering reform embrace it. As Professor Patrick McGorry AO, Executive Director
of Orygen and Professor of Youth Mental Health at the University of Melbourne stated in a
personal capacity, ‘[t]he leadership team needs to share the same inspirational vision and
commitment to transformational change.’36

As highlighted in the Commission’s interim report and described in Figure 37.2, there are five
different but equally important leadership types that are essential to a reformed mental health
and wellbeing system: policy and system stewardship; organisational leadership; clinical and
academic leadership; operational leadership; and emerging leaders across all areas.37

Figure 37.2:  Leadership types across the new mental health and wellbeing system

Effective implementation of the Commission’s recommendations will therefore require strong

leadership dispersed across different places and positions. This includes leadership from all
tiers of government and from service providers, the workforce, related systems, advocacy
organisations and peak bodies, people with lived experience of mental illness or psychological
distress, families, carers, supporters and the Victorian community more broadly.

Dispersed leadership across organisations, services, disciplines and locations will pave the
way for collaboration and collective learning opportunities. It will also embed consistency and
accountability, ensuring there is always someone responsible for reform. This will mitigate the
risk of leadership turnover, ensuring reform momentum is not lost with changes in personnel.38

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The type of collaborative leadership required to transform Victoria’s mental health system
is different from traditional hierarchical leadership; it guides rather than controls and
inspires rather than directs.39 Other leadership theories are continuing to emerge. Ensemble
leadership theory, for example, describes leadership from an Indigenous world view that is:
collective rather than individual; dynamic, rather than static; based on a social structure that
is fluid and flexible; and encompasses multiple intersecting hierarchies.40

All partners involved in implementing the Commission’s recommendations must be willing

to collaborate and take collective responsibility for reforming the system. Building collective
support by empowering leaders, both within and outside the formal boundaries of the mental
health and wellbeing system, including interrelated service systems, will be essential to
maintaining the reform momentum.41

In its evaluation of the factors that contribute to successful implementation, the Parenting
Research Centre reflected on the importance of strong unified leadership in driving broader
organisational change:

Reform may be impeded where agencies or departments are not open to new practices
or agendas. This can be perpetuated by organisational leaders entrenched in the old
culture. By contrast, new leadership may scrutinise the situation from an external
standpoint and accommodate change. This needs to be matched with retaining
expertise and corporate memory in the organisation. Either way, it can be argued
that senior management needs to be united in its commitment to change, and middle
management needs to directly manage cultural change as its leadership shapes
organisational behaviour.42

All leaders involved in the change process must be empowered to make decisions and
take risks, with an eagerness to learn and collaborate and share their knowledge and
power.43 These traits must be complemented by strong systems knowledge and the skills
and capabilities to lead and drive change. Passion and belief in the change process have
also been identified as integral to effective leadership.44 Providing evidence in a personal
capacity, Associate Professor Simon Stafrace, Chief Adviser of Mental Health Reform Victoria,
described some of the distinguishing features of effective leadership:

If the goal of mental health reform is to transform Victoria’s mental health system into
a public asset valued by the community, then leadership will be the key activity through
which this will be delivered. And if located at its heart is a capacity for driving change,
then the distinguishing features of effective leadership must surely be an ability to see
the world from multiple perspectives, a vision for what might be possible, an openness to
learning, and the courage to fail.45

It is therefore essential that all new and emerging leaders involved in reform are supported
to develop and maintain the core attributes, skills, system knowledge and competencies
required. They must also be enabled to make decisions and continue to develop and improve
by learning from previous experiences.

To strengthen and sustain leadership, the Commission’s interim report recommended

establishing a leadership network to provide for strong personal capabilities and
organisational cultures and system‑wide collaboration and oversight.46 These reforms
will be integral to preparing future leaders to develop the reformed mental health and
wellbeing system.

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Alongside these reforms, the Commission has made several recommendations to strengthen
the leadership of people with lived experience of mental illness or psychological distress,
families, carers and supporters across the reimagined mental health and wellbeing system.
In addition to these roles, it is imperative that the Victorian Government continue efforts to
identify and develop key lived experience leadership roles as new and emerging opportunities
and challenges arise throughout implementation. For this to occur, implementers must make
proactive efforts to dismantle the power imbalances that are inhibiting people with lived
experience of mental illness or psychological distress from leading and influencing change.
Strategies for distributing power more evenly across the reimagined mental health and
wellbeing system are discussed in Chapter 18: The leadership of people with lived experience
of mental illness or psychological distress. Co‑production is one example of how power can
be shared more evenly. This is discussed more in the following section.

Continued efforts must be made to strengthen, sustain and empower leaders across different
places and positions in the sector. Nurturing and developing the skills and capabilities of
leaders so they can thrive and champion reform will support this. Supports should reflect the
needs and strengths of individuals and organisations but may include providing mentorship
and opportunities to gain technical skills, as well as role‑sharing arrangements, executive
coaching, training and professional development.47 Leaders must also be encouraged to take
risks, with the opportunity to learn from their experiences and continue to adapt and evolve
their approach throughout the reform process.

Leadership must stem from within the sector, noting that leadership from the Victorian
Government alone will not be enough to drive reform. For example, fostering the leadership
capabilities of advocacy organisations and peak bodies, including the Victorian Mental Illness
Awareness Council and Tandem, will be crucial. These organisations play a pivotal role in
supporting individuals and other organisations to engage, advocate and implement reform.
Through times of major change, these organisations will be an important source of guidance
and support. It is likely that their role will also intensify as government and implementers
look to partner with them to harness their expertise and relationships across the sector.
The Commission encourages the Victorian Government to support these organisations
through adequate and stable resourcing, tailored supports and opportunities for professional
development and training.

37.2.3  Co-production and partnering

with people with lived experience
This section describes approaches to partnering with people with lived experience of mental
illness or psychological distress, as well as with families, carers and supporters. Section 37.2.5
reflects on the importance of supporting and involving the workforce and service providers
in the delivery of reform. Section 37.2.8 takes a broad view, describing strategies to support
collaboration across all the partners involved in the delivery of reform.

Redesigning Victoria’s mental health system must involve meaningful partnerships with
people with lived experience of mental illness or psychological distress, families, carers
and supporters. It is only through this process that the ambitions of the Commission’s
recommendations will be realised. As Ms Janet Meagher AM, an advocate for people with
lived experience of mental illness, stated, ‘[t]he mental health system can only assist people
to live contributing lives when the principles of involvement, genuine partnership and
empowerment are central to its operation.’48

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Ms Rachel Bateman, a witness before the Commission, made similar observations:

In order to strengthen service improvement and ensure that services are designed
in a way that genuinely meets the needs of consumers and their families and carers,
organisations need to engage in co‑production. Co‑production includes consumers
being a central part of the co‑planning, co‑design, co‑delivery and co‑evaluation
of service improvement activities. Co‑production processes should include genuine
opportunities for consumers to feel heard as equals, and opportunities for organisations
to reflect upon the power held by them and by clinical professions.49

As described in Figure 37.3, co‑production involves people with lived experience of mental
illness or psychological distress leading or partnering across all aspects of an initiative
or program from the outset—that is, co‑planning, co‑designing, co‑delivering and
co‑evaluating. Each of these phases can stand alone as a collaborative activity in and of
itself, but taken together they represent true co‑production.50

Figure 37.3:  Defining co-production

Source: Cath Roper, Flick Grey and Emma Cadogan, Co-Production: Putting Principles into Practice in Mental Health
Contexts, 2018, p.2.

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Co‑production involves equal partnerships between those involved in the project or initiative,
allowing for negotiation and compromise.51 Co‑production is different from other partnership
approaches because it values the expertise and knowledge of those most affected by the
problem and actively responds to power differentials within partnerships. In light of the
power imbalances that permeate the current system, co‑production cannot occur without
leadership from people with lived experience of mental illness or psychological distress,
with real opportunities and supports for these roles to flourish.52 As described in Chapter 18:
The leadership of people with lived experience of mental illness or psychological distress,
advisory groups with limited influence will not be able to deliver on this ambition. Elevating
the leadership of people with lived experience of mental illness or psychological distress
requires that they have decision‑making authority, with influence over policy and resourcing
decisions.53

There are great benefits in co‑producing the planning, design, delivery and evaluation
of reform initiatives so they are based on people’s lived knowledge, values, needs and
preferences. These include improved outcomes and experiences for individuals as well as
increased capacity and impact of services, and return on investment.54 Yet, as explored
throughout this report, co‑production is often poorly understood. There are tokenistic
approaches to participation, meaning that many of the benefits of co‑production
are missed.55

Ms Erandathie Jayakody, a witness before the Commission, explained:

Instead what often happens is that agenda, budget and timelines are set up without
consumer involvement and half way through the project consumers will be consulted
but only in a very limited way (often citing budgetary and time constraints). The
consultation will often occur in a very superficial way such as with respect to the colours
of a building or the name of a service.56

Dr Melissa Petrakis, Chair of Tandem, shared similar thoughts when providing evidence to the
Commission in a personal capacity:

[Consumer, carer and family workers] are expected to provide ‘the’ consumer or carer
perspective when asked, as if there is only one and as though representativeness
can be delivered without time to consult others with lived experience about the
matter at hand.57

The Commission undertook a range of activities with people with lived experience of
mental illness or psychological distress, families, carers and supporters to understand
their experiences and to design a system that reflects their needs and perspectives. The
Commission has also engaged widely across the Victorian community, drawing on the
expertise, experiences and perspectives of many to inform its recommendations. It is
imperative that implementers do not repeat the consultative work of the Commission or
revisit the decisions behind its reform agenda. To do so would be a disservice to those who
have generously shared their experiences, analysis and ideas for reform with the Commission.
Implementers must not delay; they must start building on the work of the Commission,
focusing their efforts on implementing the solutions in this report. The time for action is now.

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Co‑production in implementing the Commission’s recommendations may not always be

suitable or appropriate. Where true co‑production is not possible, partnering with people with
lived experience should nevertheless occur across as many phases as possible—for example,
in co‑planning, co‑design, co‑delivery and co‑evaluation. Depending on the purpose of the
project or initiative, there are different techniques and tools that can be used to support
these approaches.58

For example, a contributor to the Commission explained:

the nature of co‑design and co‑production is that you work with people as partners, to
understand what the problem is to design a solution to deliver and implement it. But the
Royal Commission has been doing the work of understanding the problem, and also the
beginning of designing solutions.59

The Commission has included guidance and recommendations throughout this report to
support implementers to partner with people in this way. In addition to this guidance, there
are other important factors that should be considered.

Importantly, people with lived experience of mental illness or psychological distress and
families, carers and supporters must be recognised as two distinct groups with different sets
of experiences, perspectives and expertise. While at times these groups may have shared
interests, they speak from their own perspectives and experiences and at times may have
different views.60 Approaches to partnering with these two groups must therefore be designed
to account for these varied perspectives and experiences. To this end, there are times where
the Commission has provided specific guidance to implementers on which group to partner
with. For example, in Chapter 19: Valuing and supporting families, carers and supporters,
family and carer‑led centres will be developed in partnership with families and carers.
Similarly, as described in Chapter 18: The leadership of people with lived experience of mental
illness or psychological distress, a new agency to help the emergence of organisations led by
people with lived experience of mental illness or psychological distress will be implemented in
co‑production with people with lived experience of mental illness or psychological distress.

It is important that implementers are honest and transparent about the level and types
of participation they intend to use from the outset, including establishing clear roles and
responsibilities and expectations about the process ahead.61 This is critical to accountability,
building trust, managing expectations and to the integrity of the implementation processes.

As Ms Cath Roper, Consumer Academic with the Centre for Psychiatric Nursing at the
University of Melbourne, advised:

we need to be honest about the level of consumer participation we are achieving: if

you’re consulting with consumers, then call it consultation, not co‑production. There
is nothing worse than calling something co‑production when actually the parameters
have already been set and there is no genuine possibility for moving further up the
decision‑making ladder.62

Full co‑production and other partnering approaches take time and resources. Implementers
should therefore ensure project and strategic planning efforts build in enough time to
support these approaches. Implementers must plan effectively across the various stages of a
project or initiative including factoring in the costs of remuneration and reimbursement.63

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This will ensure approaches to co‑production and partnering with people with lived
experience are authentic and avoid the risk of being sidelined by budget and time
constraints. With sound planning, there should always be a capacity to meaningfully partner
with people with lived experience of mental illness or psychological distress and families,
carers and supporters.

Approaches to partnering with people with lived experience of mental illness or psychological
distress and families, carers and supporters must also be relevant and fit for purpose.
Implementers should think about who to engage with, ensuring a diversity of perspectives
that are relevant to the context and purpose. This includes engaging with people who may
not have been heard before. Different people may also be required to participate at various
stages of the project or initiative.64 In a 2020 article published in the International Journal
of Mental Health Nursing, staff from the Centre for Psychiatric Nursing at the University of
Melbourne advised that partnering with people with lived experience of mental illness or
psychological distress can be supported by:

• ensuring a diversity of relevant perspectives, including partnering with Aboriginal

people, culturally diverse people, people living with disability, LGBTIQ+ people and
people with different experiences of treatment, care and support
• applying critical reasoning to who is selected
• involving more people
• seeking out the views of those who may have challenging perspectives.65

Importantly, power differentials between all those involved in the implementation process
must be explored and continually dismantled. This can be supported by identifying and
openly exploring power imbalances before responding. Strategies to actively shift power to
those who have traditionally held less include:

• ensuring people are provided with the supports they need to participate and lead in
meaningful ways
• setting aside time to reflect and improve partnership approaches
• outlining clear roles and responsibilities and expectations of those involved in the
partnership
• providing opportunities for people with lived experience of mental illness or
psychological distress to lead and make decisions, with real operational responsibilities
and powers to affect change
• providing opportunities to elevate the expertise, experiences and perspectives of those
who hold less power.66

37.2.4  Providing opportunities for people

to share their stories and experiences
As outlined in this report, the Commission has sought to create a reflective and evolving
mental health and wellbeing system that adapts to the changing needs and preferences
of individuals. As outlined in Chapter 36: Research, innovation and system learning, there
are many ways in which system adaptation can be supported. A further approach includes
providing opportunities for people to share their stories and experiences.

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Throughout its inquiry, the Commission has engaged with people from across Victoria and
Australia and internationally. It has been privileged to hear the deeply personal experiences
of people living with mental illness or psychological distress, and those of families, carers
and supporters, and the experiences of those working in and managing the system. Many
have shared their painful memories of the past, in the hope of shaping a better future. As one
person said:

thank you for the opportunity to tell a small part of our story and [I] look forward to the
outcomes of this much needed Royal Commission. If we can help prevent one person
from experiencing what we have gone through, I will feel it has all been worthwhile.67

People have willingly shared their powerful and deeply moving experiences. These
contributions have left a lasting impact and have provided the impetus for profound change.

While it is not the role of the Commission to substantiate the claims of individual people,
hearing these personal stories has helped the Commission to explore what lies at the heart
of individual experiences and, importantly, what needs to change. The sharing of people’s
personal experiences also played an important role in raising awareness of mental health
and wellbeing and tackling the stigma and discrimination that continues to have a pervasive
influence on the lives of people with lived experience of mental illness or psychological
distress. In many ways, this sharing has raised the level of public conversation about
mental illness.

Mr Al Gabb, a witness before the Commission, hoped that openly talking about his
experiences would help others:

for me speaking out and openly talking about it—and I’ll talk about it to anybody that
asks—it’s about helping. If I can help one person, that’s a win, that’s all that matters to
me, is to give back.68

For some, engagement with the Commission was the first opportunity they have had to share
their story formally, giving those who had not been listened to before the chance to have their
voices heard and acknowledged. As one person shared, ‘[t]hank you so much for listening. No
one ever has before.’69

While the time for consultation on what needs to be done is over, opportunities for people to
share their experiences and stories must continue throughout the implementation process.
Continued dialogue and opportunities for sharing and reflection on implementing the
Commission's reforms will be integral to generating system‑wide change. This could include
local and tailored engagement approaches such as gathering places, discussion groups,
forums, programs and events, supported by online and digital approaches. Implementers
should use these stories and experiences to sustain commitment across the Victorian
community by making the impact of reform ‘real’. 70

Providing evidence in a personal capacity, Mr David Pearl, Innovator, Author and Public
Speaker of The Studios, London, suggested that sharing individual experiences can help
people envisage a changed world, which will be critical in encouraging and inspiring all
partners throughout the reform process, ‘I think the stories that are really helpful … are stories
that generate change, that make a future state real to people.’71

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Implementers should also look to share people’s stories and experiences to help bring about
broad cultural change, countering the false assumptions and discriminatory beliefs held
by some Victorians about people with lived experience of mental illness or psychological
distress. Efforts to respond to and challenge stigma will be essential to successfully
implementing the Commission’s recommendations, ensuring good mental health and
wellbeing remains a priority in government decision‑making and for the community. As one
person shared with the Commission:

For a lot of people mental ill health, especially on an extreme level hasn’t been
experienced. It is hard for people to identify with others who do experience it if they
can’t quite understand the feelings themselves. Being able to connect with personal
stories makes it less clinical and encourages a level of connection between those who do
and don’t experience it.72

Creating opportunities for continued dialogue and discussion will also ensure an evolving and
adaptable mental health and wellbeing system that responds to the needs and perspectives
of individuals. As the National Mental Health Commission reflected:

Mental health consumers and carers hold vital knowledge about what is needed from
the system, both for individual care and at broader levels. Engagement of consumers
and carers in recovery focussed services can lead to healing of historical traumatisation
within services and promote cultural change.73

Actively engaging with and listening to the experiences of individuals will provide
implementers with early warning signs about where reform is falling short of community
expectations. This will ensure approaches to implementation can be refined and adapted,
responding to emerging challenges.

The Commission acknowledges that some people have called for a formal process through
which they can have their experiences and their stories heard, including, for example, a
consumer‑led truth telling and reconciliation process.74 While it is outside the remit of the
Commission to formalise processes such as this, the experiences, perspectives and expertise
of people with lived experience of mental illness or psychological distress, families, carers and
supporters have been central to its work. These contributions underpin the narrative, reform
agenda and recommendations outlined in this report.

As reform progresses, the Commission envisages that the mental health and wellbeing system
will continue to create opportunities for people to share their individual stories and experiences.
The recommended strategies for enabling the leadership of people with lived experience of
mental illness or psychological distress outlined in Chapter 18: The leadership of people with
lived experience of mental illness or psychological distress, will support this endeavour.

Creating the space for people to share their stories and have their experiences heard and
acknowledged, however, will be the responsibility of all those involved in implementing
the recommendations contained in this report—this includes the entities created by the
Commission, and the existing agencies, organisations and individuals involved in the mental
health and wellbeing system. This will involve enquiring into and engaging with the individual
experiences and perspectives of those who use and work within the system, and seeking out
diverse views and perspectives, including those of people who have previously been silenced
or excluded.

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Continued dialogue, reflection and the sharing of individual experiences and stories is
essential to rebuilding the Victorian community’s trust in the mental health and wellbeing
system and to creating a system that is flexible and respects people’s needs and experiences.

37.2.5  Supporting and involving service

providers and the workforce
The perspectives of the workforce, including the leadership of a range of service providers,
are also integral to successful implementation. The workforce—as the heart of the Victorian
mental health and wellbeing system—will play a crucial role in translating the Commission’s
vision into action. The workforce must be supported and involved in implementation from the
very start.

There is considerable optimism and readiness for change within the workforce. A workforce
survey that the Commission engaged ORIMA Research to undertake suggests that almost all
respondents personally felt ready for changes to the mental health system, with 90 per cent
of respondents indicating they believed change was necessary in the mental health setting
where they worked.75

When asked what would help to prepare them for changes to the system, ‘[r]eceiving clear
communication and being kept informed throughout the changes’ was rated as the most
important factor, followed by ‘[a]ccess to relevant training, professional development, and
practice support.'76 Some specific suggestions for improving how change is managed across
the mental health system included an ‘opportunity to collaborate in the proposed changes,
necessary resources and positive workplace culture’77 as well as ‘being consulted about
how to best implement changes locally’.78 These results suggest there is an opportunity to
capitalise on the enthusiasm and expertise amongst the workforce by involving them in the
implementation of reforms.

Leaders from a range of organisations involved in service delivery will also play a pivotal
role, steering their own organisations, including individuals, teams and associated systems,
through a substantial period of change and innovation. Associate Professor Stafrace
described how leaders of organisations can influence outcomes for the better by shaping
‘the pattern of beliefs, values, and behavioural norms that represents the shared learning
of the organisation as it solves the problems it confronts’.79 In this way, their support for
implementation will be critical. Garnering that support will require the Department of Health
to actively seek and involve leaders from a range of organisations involved in service delivery
throughout the implementation process. This will also help to ensure that the translation of
the Commission’s reforms and enablement of change across the system is informed by a
deep understanding of what works on the ground, at the point of service delivery.

37.2.6  Evaluation throughout reform

As discussed in Chapter 36: Research, innovation and system learning, an adaptive mental
health and wellbeing system relies on research and evaluation to inform the design and
delivery of effective and innovative treatment, care and support. While the importance of
evaluation is detailed elsewhere in this report, it is brought to the fore here as an essential
component of ongoing implementation efforts.

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Evaluation is a critical part of ensuring reform implementation can adapt to changing needs.
It indicates what works and what does not work, and for whom, in what context and why.
Evaluation can also shift power to people whose voice might otherwise not be heard by giving
them a say about decisions and services that affect their lives.80

Evaluation should be included from the beginning of implementation,81 using success

measures that are established during the planning stage.82 This allows for an iterative
development and implementation process where evidence is collected and used to make
adjustments along the way, and to ensure changes are implemented effectively.

The balance between planning and responding to feedback ‘on the go’ was discussed
in an essay published in Delivering Policy Reform: Anchoring Significant Reforms in
Turbulent Times:

We also know … that policy reforms cannot anticipate all factors and contingencies;
there will inevitably be a great deal of learning and adjustment in order to meet these
realities. [Implementation must manage] the tensions between seeking durability in
policy reforms and making improvements or adjustments in light of feedback from
those responsible for implementation and evidence on the performance of the policy
and programs without losing the integrity and momentum of the original reforms.83

Rigorous evaluation also builds momentum for change by indicating the benefits of the
approach—when people can see that what they are doing is having a positive impact, and
achieving an aim, it helps them to keep up their commitment. Exemplifying how reforms will
make a difference to individuals’ experiences and outcomes, as well as for service providers,
governments and the public, helps to build people’s confidence and engagement in the
change effort.84 This is particularly important because reform efforts will take time to deliver.
For example Joannah Luetjens of Utrecht University, Professor Michael Mintrom of Monash
University and Professor Paul ‘t Hart of Utrecht University made the following observations
about reforms to make Melbourne more ‘liveable’ in Successful Public Policy, Lessons from
Australia and New Zealand:

In the case of the drive to make Melbourne a more liveable city, there were various
challenges that meant implementation occurred in a slow, incremental fashion … When
people started to see the benefits of the implementation efforts, assessments of the
overall initiative became far more positive.85

Continually evaluating the impact of reforms and sharing the knowledge obtained not only
gives people visibility of how well new approaches are working (thus building confidence in
reforms). It also enables better decisions at the system and service levels—for example, about
what initiatives to invest in and at what scale. Therefore, evidence plays a crucial role in
guiding the expansion of what works so the full benefits can be understood and realised.86

In thinking about what constitutes evidence, the Commission encourages implementers to

adopt a broad approach. Data collection, research and the perspectives of people with lived
experience of mental illness or psychological distress, families, carers and supporters as well
as the workforce must be actively sought, considered and acted on.

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It is important to note, however, that scaling up and expanding effective approaches must
be tailored to and reflect the local context.87 When expanding programs or initiatives,
implementers must take care to strike the balance between ensuring efforts respond to the
identity and culture of communities while maintaining a level of consistency and fidelity to
the model.88

Continuous evaluation implicitly acknowledges one important fact: not all efforts will be
successful on their first attempt. Implementation of substantial reform necessarily involves
new and innovative ways of doing, including approaches and initiatives that have never
been attempted before. To innovate and take these risks, implementers must have both
the permission and the courage to try, with the opportunity to learn from their experiences
and adapt future approaches. This is also important to achieving momentum. Delaying
decisions and progress towards a reformed mental health and wellbeing system may
compromise Victorians’ trust in reform—in some ways, perhaps, more than unsuccessful first
attempts would.

In Chapter 36: Research, innovation and system learning, the Commission has recommended
an approach to build evaluation activity and capability across the redesigned mental
health and wellbeing system, including developing a rolling three‑year evaluation program
to promote system learning. The Commission notes the Productivity Commission’s Mental
Health Inquiry Report recommendation that a national body be established to promote
a culture of evaluation, commissioning program evaluations, and building evaluation
capacity and capabilities.89 This body would build and maintain partnerships with research
institutes and state and territory partners and ‘evaluate aspects of the system that are of
national significance or that relate to multiple jurisdictions’.90 But this ‘does not obviate the
responsibility for all governments’ to monitor and evaluate programs.91 A dedicated mental
health evaluation function in Victoria should form a strong relationship with the national
body and receive funding to undertake program evaluations that would have national
interest. These collaborative activities will enable Victoria to assess, grow and extend
approaches so Victorians can connect with high‑quality treatment, care and support.

37.2.7  Financial commitment

In recent decades, Victoria’s mental health system has suffered from marked
underinvestment and deprioritisation, contributing to increasing unmet demand for mental
health services.92 As a result, many people do not get the treatment, care and support they
seek, when it would make the most difference.

The Commission recognises that the Victorian Government will be implementing its
recommendations within a fiscally constrained environment, particularly as a result of
the COVID‑19 pandemic. For the first time since 1991, in July 2020 Australia found itself in
recession.93 While technically it has since ‘emerged’, the federal Treasurer, the Hon. Josh
Frydenberg MP, has warned that Australia’s economic recovery is far from over.94

While this context is important, it is the firm view of the Commission that the impacts of
the COVID‑19 pandemic on individuals and communities—including social isolation and
unemployment rates—necessitates a strong focus on mental health and wellbeing and its
prioritisation in future budgets.

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The costs of poor mental health are borne by everyone; people living with mental illness or
psychological distress are most affected, but families, carers, supporters, governments and
employers also incur costs. In its interim report, the Commission estimated that poor mental
health costs Victoria $14.2 billion a year.95 Australia‑wide, too, the costs of poor mental health
are enormous. The Productivity Commission's Mental Health Inquiry Report estimates the
economic costs to the country of poor mental health and suicide in 2018–19 to range from
$43 billion to $70 billion. It anticipates that these costs are likely to increase in response to
the COVID‑19 pandemic and the 2019–20 severe bushfire season, with predicted widespread
implications for the mental health and wellbeing of all Australians.96

Investment in good mental health and wellbeing has been at the fore of the Commission’s
thinking throughout the conduct of its inquiry. Anticipating the considerable work needed
to redesign the system, the Commission’s interim report recommended a new approach
to mental health investment to both deliver a substantial funding increase and ensure
that funding is best distributed and used throughout the reformed mental health and
wellbeing system—a new levy and a dedicated capital investment fund.97 The design and
implementation of this new approach to investment will be critical to ensuring sustainable
and enduring reform. Should the new levy and dedicated capital investment fund be delayed,
the Commission expects the Victorian Government to demonstrate its commitment by
allocating investment from general revenue as part of the annual budget process, to pave the
way for major, sustained investment in good mental health and wellbeing.

The Victorian Government has recently shown it is willing to invest in the good mental health
and wellbeing of Victorians. Through the 2020–21 State Budget, it has announced measures
to rebuild the economy and to respond to the ‘cracks’ exposed by the COVID‑19 pandemic.
This includes a commitment of almost $870 million to implement the recommendations made
by the Commission in its interim report to repair a ‘frail mental health system’.98 As the Hon.
Tim Pallas MP, Treasurer of Victoria articulated:

this year has tested us emotionally and it has revealed the very deep cracks in our
mental health system. This year’s Budget invests nearly $870 million to ensure Victorians
have the mental health support they need as we get on with fixing a broken system.99

The Commission is encouraged by the way the Victorian Government made mental health
a priority in response to the COVID‑19 pandemic. This investment, however, is just the
beginning. The scale of funding required to redress historical underinvestment and meet the
future needs of the Victorian community is enormous. Yet, as explored in the Commission’s
interim report there is a compelling case for increasing investment in mental health.
Increased funding in Victoria’s mental health and wellbeing system would provide a range of
benefits including: opportunities to tackle inequity and design a system that is fair and just
for all; improved social and economic participation that will boost the economy; and health
benefits, including improvements to Victorians’ quality of life and life expectancy.100

While increased funding alone will not fix all the problems in the mental health system, strong
and sustained investment will be vital to delivering on the reforms outlined in this report and
to ensuring future savings.

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The Productivity Commission Mental Health Inquiry Report reached similar conclusions,
suggesting that if Commonwealth, state and territory governments spent $3.5–$4.2 billion
to deliver major reform across the system, this would result in estimated savings due to
increased productivity and good quality of life of $1.7 billion, and increases to total income
earned of up to $1.3 billion per year.101 The Commission believes that these investment
estimates are modest for Victoria, given the historical underinvestment in the mental
health system in the state. The reality of past underinvestment means there will need to be
substantial spending put in place for the fundamental elements that will enable large‑scale
change across the state. Only once that has happened will the Victorian community and
economy see the benefits the Productivity Commission envisages for Australia.

The Victorian Government will need to continue making the mental health and wellbeing of
the Victorian community a priority as it makes funding decisions. It should also explore ways
to coordinate investments with other levels of government—for example, by forming new
partnerships—to best meet Victorians’ mental health and wellbeing needs and preferences.

37.2.8  Collaboration
The scale and complexity of the task ahead, and the fact that implementation of many
reforms will occur in parallel, means that government, service providers, the workforce,
people with lived experience of mental illness or psychological distress, families, carers,
supporters and the Victorian community will need to collaborate effectively.

Successful collaboration ‘require[s] a shared vision, objectives and methodology, utilising the
skills and expertise of all parties’.102 It involves ‘creating new structures within which to embed
authority, developing a common mission, engaging in comprehensive and shared planning,
and in which formal communication across multiple levels occurs’.103

Effective collaboration also requires a willingness to be transparent so that ‘both sides

understand each other and are able to align vision of the partnership with their shared
goals’.104 It needs a commitment to regular and direct communication and mutual trust, which
is especially crucial when challenges emerge.105

Dr Tricia Szirom, the then CEO of the Victorian Mental Illness Awareness Council, reflected on
the benefits of collaborative efforts in solving complex problems:

when you bring people with diverse backgrounds together, you can solve complex
problems, particularly as you are able to bounce your ideas off one another and you all
bring with yourself a different perspective.106

A report by the Australian New Zealand School of Government made similar observations
about the importance of collective problem solving:

public problem‑solving skills are directed not at convincing others that one is right, but
at harnessing the collective intelligence of others to develop a deeper and more realistic
understanding of both problem and solution, and to evolve along with them. We cannot
be as smart alone as we are together, taking advantage of our diverse intelligence.107

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Collaboration can also help to ease the transition to new arrangements. For example, at the
Commission’s public health roundtable, participants highlighted strong potential to improve
public health efforts for mental health in Victoria through collaborative efforts, but that the
transition to new arrangements and managing new complexities may be challenging.108

As described earlier, Victoria’s mental health sector has been divided and at times has
struggled to achieve a consistent and unified voice.109 The Commission considers that this
may be partly explained by the historical and structural pressures facing the system. While
the Commission’s aspiration is for a unified mental health and wellbeing system where
collaboration can flourish, in reality there are several pressures—in particular, demand for
services and a shortage of workers—that will continue to test collaborative efforts.

Over the past 30 years, demand for mental health services has increased, and this is only
likely to continue.110 It is also anticipated that as community awareness and understanding
of mental health and wellbeing continues to develop, in part due to this inquiry, so too will
demand for services. This has been evident with comparable reforms; for example, the
Implementation Monitor of the Royal Commission into Family Violence acknowledged the
increasing demand when the sector was reformed:

Demand for services continues to grow, likely due in part to the increased community
awareness of family violence the reforms have supported. The existing system needs
to simultaneously grow and reform while meeting the immediate needs of victim
survivors. This is a pressure being felt across all areas of government and community
organisations …111

The Implementation Monitor of the Victorian Bushfires Royal Commission made similar
observations, suggesting that recent inquiries into the sector had increased public interest
and expectation:

The public conduct of the [Victorian Bush Fires Royal Commission] and [other] inquiries
… show that the community is interested in what is going on and has an expectation
that if problems or failures in response to a disaster or emergency event are identified,
then these will be swiftly rectified to ensure the ongoing protection of the community.112

Increasing demand places pressure on all aspects of the mental health and wellbeing system,
with flow‑on effects to interrelated service systems. This in turn places considerable pressure
on the workforce and those managing the system. Responding to increasing demand for
mental health and wellbeing services cannot be the responsibility of one part of the system
alone. Effectively responding to demand requires collaboration between all parts of the
system—governments and service providers alike. Collaboration can help ensure the needs
of a population are well understood by Victorian and Commonwealth governments and
that subsequent investments are complementary and coordinated towards the areas of
greatest need—minimising duplication of effort and the risk of service gaps. At the service
delivery level, collaboration between service providers can help ensure people receive the
right services when it would make the most difference to them, reducing the need for higher
intensity service responses.

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Responding to demand and reforming the mental health and wellbeing system simultaneously
will be a major challenge. Faced with these pressures, there may be a temptation for
implementers to respond to demand in isolation of the Commission’s recommended
system‑wide approach—for example, by resourcing existing mental health services based on
historical approaches. Yet this would be a missed opportunity, given responding to demand
cannot be done by simply more investment. New and innovative approaches to mental health
and wellbeing must be explored concurrently and collaboratively.

Alongside increasing demand, the mental health workforce will also continue to face
substantial resourcing challenges, with shortfalls across professional groups in specialist
public mental health services expected to worsen over time.113 As explored in Chapter 33: A
sustainable workforce for the future, proactive efforts to substantially expand the workforce,
develop new roles and support new and enhanced capabilities will be essential to effectively
implementing the future mental health and wellbeing system.

In light of these pressures, proactive efforts must be made to unite and strengthen the
sector so all partners involved in delivering reform can work together to achieve systemic
change. Recognising the importance of collaboration to reform, the Commission’s interim
report recommended establishing the Victorian Collaborative Centre for Mental Health and
Wellbeing to bring together people with lived experience of mental illness, families, carers and
supporters, researchers, academics and clinicians to improve service delivery and research.
As a contemporary facility with statewide leadership and delivery functions, the Collaborative
Centre will encourage greater collaboration. But it is only one entity within a broad system. It
is essential that the entire system has an equally strong focus on collaboration.

Fostering collaborative efforts across the sector, while at the same time responding to
emerging and historical pressures, will be supported by defined objectives, roles and
responsibilities,114 with ongoing efforts to acknowledge, explore and confront power
imbalances.115 Implementers must also take care to develop decision‑making structures in
which the different needs and perspectives of individuals and groups can be considered,
including through regular consultation and clearly defined accountability. Dr Peter Shergold,
former Secretary of the Department of the Prime Minister and Cabinet and current Chair
of the Centre for Social Impact, recognises that there are often ‘competing interests’ and
‘different perspectives’ that can only be understood and attended to through a process of
‘interaction and negotiation’.116

Implementers should employ a range of strategies to enable effective collaboration. This

could include, for example undertaking appropriate planning to build in enough time to
support collaborative approaches and developing tailored engagement strategies and
communication channels.117 It is important, however, that these activities are designed to aid
implementation—not delay it.

Because the Victorian public will be partners in delivering reform, it will be important to
create a shared sense of purpose with them to maintain momentum. As described earlier,
there is a strong appetite in the Victorian community for system‑wide change. Presenting a
compelling vision for reform, using the media effectively and identifying champions to lead
reform will help to capitalise on this desire for a new system.118

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Making sure the public has visibility over the reform process can help maintain trust,
including the trust of people with lived experience of mental illness or psychological distress.
This can be achieved by regularly updating people on the reform work such as through
regular progress updates via a dashboard or website and monthly reports, which can also
include information on opportunities for participation.119

37.2.9  Strong governance structures

Strong governance structures will be integral to implementing reform; they can clearly define
the intended scope of reform and clarify the roles and responsibilities of all those involved in
implementing it, helping them to work together.120

The Family Violence Implementation Monitor described the risks of not having clear
governance structures:

Clear governance arrangements are critical to the successful implementation of

any major reform. Without these, there is a significant risk that accountability will be
blurred—meaning it is unclear who is ultimately responsible for a particular decision
or risk. Consequently, implementation decisions may be poorly informed and possibly
taken at the wrong level of government, without adequate input from relevant
agencies. Alternatively, gaps in decision making and risk management may arise as
groups are unsure of their responsibilities, or decisions may be made in isolation in
different agencies.121

Alongside establishing accountability for reform, governance structures also play a critical
role in ensuring it is clear who has authority over what, therefore enabling decision‑making.
An independent review of the Australian Public Service made the following observations about
good governance in enabling and supporting the change process, ‘[i]t empowers and guides …
leaders to make good decisions without unnecessary delay, and ensures public resources are
deployed properly and effectively. It supports the organisation to act with integrity.’122

To support implementation, the Commission has established a range of governance

structures which are summarised in Figure 37.4. As outlined in Chapter 27: Effective
leadership and accountability of the mental health and wellbeing system—new system‑level
governance, this includes establishing government‑wide and community‑wide approaches
to improving mental health and wellbeing, including a Mental Health and Wellbeing
Cabinet Subcommittee, and a Mental Health and Wellbeing Secretaries’ Board, a Suicide
Prevention and Response Secretaries' Board Subcommittee and an Interdepartmental
Committee on Mental Health and Wellbeing Promotion, which will oversee implementation
of the Commission's recommendations. These structures, which include leadership from
the Premier and senior ministers, should be established as a priority to ensure there
are clear arrangements in place to support effective decision making and enable the
timely implementation of the Commission’s recommendations. It is also anticipated that
governance arrangements will continue to mature and evolve as reform progresses and
the system is redesigned. This is evident, for example, in the Commission’s recommended
approach to establishing Regional Mental Health and Wellbeing Boards, which will adopt
their functions through a staged approach to implementation. This approach will support
development of new capabilities and skills, allowing for trusting partnerships between the
Department of Health, the new entities, service providers and the community to be developed
as reform progresses.

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Figure 37.4:  Summary of new system architecture

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Implementing the Commission’s recommendations will require a collective approach

across different parts of the Victorian Government. This reflects that there are a range
of circumstances that contribute to people’s experiences of mental health and wellbeing,
including social and cultural characteristics, environmental events and neighbourhood,
economic and demographic factors.123 A collective and coordinated effort across government
portfolios, such as education, justice and community services, is therefore required to ensure
people are supported to experience their best mental health and wellbeing. The importance
of a collaborative governance approach in delivering complex reform was emphasised in
an independent review of the Australian Public Service, which states that ‘single agencies
working relatively independently of each other can miss opportunities to deliver seamless
services to Australia or robust advice to government on complex challenges that cut across
portfolio boundaries’.124 The scale of reform ahead will therefore require collaboration and
leadership across many government departments. This is particularly pertinent in the
context of recent changes that saw the Department of Health and Human Services separated
into the Department of Health and the Department of Families, Fairness and Housing.125
As outlined in Chapter 3: A system focused on outcomes, accountability and collaboration
across government departments and agencies will be fostered through a Mental Health and
Wellbeing Outcomes Framework.

The Victorian Mental Illness Awareness Council advocated for an integrated system‑wide
approach to governance:

changes to the mental health system will require strong integrated system‑wide
governance to ensure that the vision of the Commission for consumer‑centred
and consumer‑acknowledged leadership is implemented and maintained over
future years.126

This approach to governance will bring with it a number of challenges. But with the
right structures, funding, people expertise, and accountabilities in place, governance
arrangements that involve a number of parties will play a critical role in driving and
implementing change and improving outcomes for people living with mental illness or
psychological distress, families, carers and supporters.

As Ms Lin Hatfield Dodds, Associate Dean for the Australian and New Zealand School of
Government of the Crawford School at Australian National University stated in a personal
capacity:

Collaboration is hard, grinding, and resource intensive. If it were easy, our federation would
work more efficiently and consistently deliver seamless service systems for citizens. When
properly resourced, collaboration across types of organisations and levels of government
is generally highly effective in delivering outcomes and value for communities.127

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Alongside the structures recommended by the Commission, implementers should also

consider whether other arrangements are necessary to ensure a coordinated and
collaborative approach to implementing specific recommendations. While governance
arrangements will vary depending on the purpose and scope of the reform agenda, the
Centre for Evidence and Implementation identified the following principles for good
governance in facilitating collaboration for reform:

• legitimacy and voice—ensuring those who should and need to be represented are
supported to actively participate and collaborate
• strategic vision—stating a clear direction and strategic vision with goals and
objectives, ensuring all partners understand their role in achieving change
• performance—monitoring and reporting on progress towards reform and making
necessary adaptations
• accountability—facilitating a culture of openness and transparency and ensuring
clarity about the accountabilities of different individuals and the collective
• fairness and equity—ensuring all those involved get value from the process and
applying the principles of equity, inclusion and diversity across all aspects of
governance.128

Lessons should also be drawn from comparative reforms. For example, an interdepartmental
committee was established to oversee all of the reforms planned by the Royal Commission
into Family Violence. However, there were several problems identified with its structure,
including that it lacked clear purpose and decision‑making authority.129 These challenges
emphasise the importance of putting in place strong decision‑making structures with
defined roles for each governance body and guidance on how they intersect. Past challenges
also show the importance of having a single point of accountability for system reform.130 For
governance structures to be successful, it will be essential to establish clear priorities and
ways of working together, including information‑sharing protocols to ensure work programs
are coordinated.

37.2.10  Monitoring implementation of the

Commission’s recommendations
Effective monitoring is essential to implementation, playing an important role in: maintaining
momentum for reform; embedding accountability for change; ensuring progress is
transparent; mitigating and avoiding unintended consequences; and continuously improving
and adapting reform efforts.131

The Parenting Research Centre identified three important features of effective monitoring for
successful implementation—transparency; independence and sustainability132—suggesting
that, ‘[a]n external oversight body may be necessary for the effective monitoring and
evaluation of implementation, ensuring accountability.’133

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In line with these features, as described in Chapter 27: Effective leadership and accountability
of the mental health and wellbeing system – system-level governance, the Commission
recommends that the new Mental Health and Wellbeing Commission will be responsible
for examining and overseeing implementation of the Commission’s recommendations. As
an independent statutory authority, the Mental Health and Wellbeing Commission is best
placed to provide independent scrutiny and oversight, holding implementers to account
for fulfilling the aspirations of the Victorian community. This includes annual public
reporting to parliament while the Commission’s recommendations are being implemented.
Importantly, the new Mental Health and Wellbeing Commission will also include leadership
from people with lived experience of mental illness or psychological distress and families and
carers, ensuring lived experience oversight over the implementation of the Commission’s
recommendations.

A transparent and independent approach to monitoring reflects similar approaches adopted

to oversee large‑scale reforms. For example, the Victorian Bushfires Royal Commission
recommended establishing an independent implementation monitor to ensure ‘government
and the community have access to transparent, independently verified information on the
response to the Commission’s recommendations’.134

The Royal Commission into Family Violence took a similar approach, recommending an
independent statutory agency be established to, among other things, monitor and report on
the implementation of its recommendations.135

Effective monitoring must go beyond providing a ‘scorecard’ or a ‘tick the box’ exercise. For
example, while information on output measures or analysis of how much money has been
invested is important, it does not reflect whether the reform has had the intended impacts.136
The Mental Health and Wellbeing Commission must therefore engage widely across the
sector to gather information and assess whether implementation efforts are meeting the
needs and preferences of people with lived experience of mental illness or psychological
distress, families, carers and supporters.

It is important too that approaches to monitoring implementation efforts do not solely

focus on finding fault or attributing blame. Instead, a positive and supportive approach will
motivate, guide and help implementers to learn and adapt their approach. As one participant
told the Parenting Research Centre in an in‑depth interview about their experience of
implementation,137 ‘[implementers needed to see that monitoring is] there to help, not to
beat them up … so that together we could work in a collaborative way to create change’.138 To
this end, the Mental Health and Wellbeing Commission must provide advice to improve the
effectiveness of the implementation process and suggest strategies to tackle emerging risks
and problems.

Monitoring and publicly reporting on implementation of the Commission’s recommendations

is vital to ensuring real progress is made to improving the experiences and outcomes of
people with lived experience of mental illness or psychological distress, families, carers and
supporters. It is also critical for making sure governments and implementers are accountable
to the public.

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37.3  Implementing the reimagined

mental health and wellbeing system
As explored throughout this chapter, large‑scale transformation requires partnerships with
people with lived experience, as well as effective collaboration, strong governance structures
and collective leadership. It also requires a strategic approach to planning over time, not
just a ‘project plan’. This could be achieved by developing detailed, staged implementation
plans, with clear explanations of responsibilities, engagement processes, timelines, costs and
evaluation points.

Because of the complexities associated with implementation, the reform activity following
this Commission should be staged or sequenced. As Associate Professor Stafrace stated,
‘[r]eform takes time. The most successful examples involved building momentum over time.’139
Associate Professor Vine also encouraged an incremental approach to implementation:

improvement needs to be incremental—as a big part of reversing the decline involves

developing new services, improving amenity and re‑invigorating a workforce that in
places has become de‑skilled and dis‑engaged. Such improvement will take time.140

A planned approach to implementation can help facilitate a measured and achievable

process.141 A well‑considered pace of change can also enable improvements and adaptations
to be made over time, accommodating new information and intelligence as reform progress.142

Implementers must strike the balance, however, between the pace and scale of reform and the
urgency required to deal with the depth of the problems in the existing mental health system.
There is a moral imperative for implementers to capitalise on the opportunities afforded
by this inquiry. Timely, deliberate and sustained actions are therefore required to ensure all
Victorians can benefit from the changes described in this report, both now and into the future.

Implementation generally occurs in stages or phases143 including sequencing across time

horizons or ‘waves’ of reform over the short, medium and longer term. Generally, these
approaches begin by implementing the critical enablers of reform first—processes and
policies that must be in place before further changes or initiatives can be introduced.
As described in Chapter 26: Rebalancing mental health laws—a new Mental Health and
Wellbeing Act, in the context of the Commission’s recommendations this includes immediate
legislative reforms via a new Mental Health and Wellbeing Act, which should be introduced
into parliament as soon as possible, ideally by the end of 2021. Early implementation of priority
recommendations is also important to maintaining the reform momentum, ensuring the
problems these recommendations seek to rectify are front and centre in public discourse.144

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When considering the staging of reform, it is important to identify and plan for what skills
and capacity will be needed to implement reforms, not just in the short‑term but over
many years.145 The Royal Commission into Institutional Responses to Child Sexual Abuse,
for example, acknowledged the importance of a phased approach in achieving long‑term
cultural change, providing institutions, regulatory bodies and governments with time to build
their capabilities and capacity for large scale change.146

When sequencing reform activities, then, implementers should consider the time required
to build sufficient capacity and readiness for reform while also allowing for the evaluation
needed to adapt and scale up successful approaches.

The Commission has consistently considered the potential resourcing, time and effort
required to implement the changes it has recommended. It also considered the sequencing
of its reform agenda, identifying the main steps or activities that may form the basis of an
implementation plan. This section provides a consolidated overview of the Commission’s
reform agenda and indicative sequencing.

37.3.1  Waves of reform: main steps and sequencing

The Commission’s terms of reference direct it to develop recommendations that are
‘appropriate for the short, medium and long term’.147 The Commission has articulated a
10‑year reform agenda, comprising three waves of reform at Table 37.1:

• short term—by the end of 2022

• medium term—by the end of 2026
• long term—by the end of 2031.

This section provides an overview of the reform agenda. Table 37.1 presents the main
components of each recommendation and provides an overview of associated timeframes
for implementation. The timeframes depicted in Table 37.1 are the period within which
implementation processes will commence and the major steps associated with the delivery of
each component of the recommendation undertaken. It is noted that some recommendations
include a specific and articulated deadline against componentry (for example, ‘by the end
of 2022’), which means all major steps must be complete by this date. Some timeframes in
the table extend through to the end of 2031, noting they are in the main associated with
ongoing governance arrangements. The presentation of the Commission's recommendations
in this way is intended to provide the Victorian Government with a starting point to aid the
implementation process. It also serves to illustrate what reforms the Commission considered
are priorities, and what may take more time.

It is important to acknowledge, however, that system‑wide reform will not be achieved simply
by implementing the Commission’s recommendations. The Family Violence Implementation
Monitor described the key deficiencies of this assumption:

The emphasis on acquittal means the recommendations are driving reform

implementation. This is problematic because, while the recommendations of the Royal
Commission are a critical input to the design of the reform and the implementation plan,
and acquitting them is an important accountability exercise, they are not sufficient to
drive the implementation of the reform. They provide neither sufficient detail nor the
necessary systemic approach. 148

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Instead, implementers must take a systemic approach and consider how recommendations
work in parallel to achieve the changes envisaged by the Commission, including how
all of the components of the redesigned system will fit together149 and the impacts of
recommendations on other parts of the system and interrelated services. As described earlier,
the recommended Mental Health and Wellbeing Commission will also assist by monitoring
implementation efforts and supporting implementers to learn and adapt their approach.

It is important to note that while the Commission has articulated a 10‑year reform agenda,
implementation is not a static or linear process; reform will be ongoing and dynamic, requiring
‘consistency, resilience, and perseverance’150 from all those involved in implementation.

37.3.2  The time to act is now

While the Commission has reached its end, its ambitions for a reimagined mental health and
wellbeing system are far from realised. Next, the Commission’s recommendations must be
effectively implemented, and this will require unwavering commitment from government and
all partners involved in its reform.

While the work ahead will not be easy, there is hope that this time will be different—that all
possible efforts will be made to give the recommended reforms the best chance of success.
The Commission calls on implementers to make the hopes of people with lived experience of
mental illness or psychological distress, families, carers and supporters a reality.

The Victorian public’s optimism and desire for change gives implementers a unique opportunity
to create enduring reform. All partners in delivering profound change must rise to the challenge.
The Commission’s inquiry is over; the time for decisive and deliberate action is now.

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Table 37.1:  Implementation table

Recommendation 1:

Supporting good mental health and wellbeing

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. build on the interim report’s nine recommendations and develop

a Mental Health and Wellbeing Outcomes Framework to drive
collective responsibility and accountability for mental health and
wellbeing outcomes across government portfolios.

2. through a newly established Mental Health and Wellbeing Cabinet

Subcommittee, chaired by the Premier (refer to recommendation
46(2)(a)), use the Mental Health and Wellbeing Outcomes Framework
to monitor outcomes to inform planning and policy decisions.

3. use the Mental Health and Wellbeing Outcomes Framework as a

mechanism to inform government investment processes and assess
the benefits, including the economic benefits, of early intervention.

4. update the Mental Health and Wellbeing Outcomes Framework and

publicly report on progress against outcomes at a service, system
and population level, every year.

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Recommendation 2:

Governance arrangements for promoting good

mental health and preventing mental illness

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. establish within the Mental Health and Wellbeing Division, a Mental

Health and Wellbeing Promotion Office, led by a Mental Health and
Wellbeing Promotion Adviser, who reports to the Chief Officer for
Mental Health and Wellbeing (refer to recommendation 45(1)).

2. enable the Mental Health and Wellbeing Promotion Office to develop

and coordinate a statewide approach to the promotion of good
mental health and wellbeing and the prevention of mental illness
which:
a. delivers the economic and social benefits of good mental health
and wellbeing across the population;
b. is informed by public health principles;
c. promotes and is informed by human rights; and
d. focuses on reducing inequities in mental health and wellbeing
outcomes.

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Recommendation 3:

Establishing a responsive and integrated

mental health and wellbeing system

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. establish a responsive and integrated mental health and wellbeing

system, in which people receive most services locally and in the
community throughout Victoria, close to their families, carers,
supporters and networks.

2. establish service delivery across Victoria at local, area-based and

statewide levels comprising:

a. between 50 to 60 new Adult and Older Adult Local Mental Health

and Wellbeing Services that operate with extended hours and are
delivered in a variety of settings;

b. 22 Adult and Older Adult Area Mental Health and Wellbeing

Services delivered through partnerships between public health
services or public hospitals and non-government organisations
that deliver wellbeing supports;

c. 13 Infant, Child and Youth Area Mental Health and Wellbeing

Services delivered through partnerships between public health
services or public hospitals and non-government organisations
that deliver wellbeing supports; and

d. statewide services that are delivered in a way that minimises the

need for people to travel far to access services.

3. for planning and governance purposes, realign existing boundaries

and organise mental health and wellbeing services across eight
regions (refer to recommendation 4).

4. remove rigid boundaries (or catchments) for service delivery based

on where people live.

5. establish the requirements for each service and the links between
them through a ‘service capability framework’.

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Recommendation 4:

Towards integrated regional governance

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. by mid-2021, establish eight interim regional bodies to provide advice

to the Mental Health and Wellbeing Division in the Department of
Health as it plans, develops, coordinates, funds and monitors a range
of mental health and wellbeing services in each region.

2. by no later than the end of 2023, replace interim regional bodies with
legislated Regional Mental Health and Wellbeing Boards to:
a. undertake workforce, service and capital planning for mental
health and wellbeing services; and
b. lead engagement with their respective communities.

3. from the end of 2023 and by no later than the end of 2026, enable
each Regional Mental Health and Wellbeing Board also to:
a. commission mental health and wellbeing services; and
b. hold individual providers to account to improve the outcomes and
experiences of people who use their services.

4. in parallel with the establishment process, ensure that Regional

Mental Health and Wellbeing Boards:
a. acquire and maintain the required skills and capabilities to
perform the above functions;
b. are accountable for the delivery of agreed outcomes through new
accountability arrangements; and
c. are skills-based and include at least one person with lived
experience of mental illness or psychological distress and one
person with lived experience as a family member or carer.

5. with the assistance of the interim regional bodies, establish a

multiagency panel in each region to coordinate as required the
delivery of multiple mental health and wellbeing services for people
living with mental illness or psychological distress, including children
and young people, who may require ongoing intensive treatment,
care and support.

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Recommendation 5:

Core functions of community

mental health and wellbeing services

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. commission and ensure that Adult and Older Adult Local Mental
Health and Wellbeing Services and Adult and Older Adult Area
Mental Health and Wellbeing Services referred to in recommendation
3(2)(a) and (b) work in collaboration to deliver in each of the 22
service areas short-term, ongoing and intensive services as required
and include the following core functions:
a. Core function 1: integrated treatment, care and support that
comprises:
• a broad range of treatments and therapies;
• a broad range of wellbeing supports (formerly called
psychosocial supports) for those who require them, including
those who are unable to access the National Disability
Insurance Scheme;
• education, peer support and self-help; and
• care planning and coordination.
b. Core function 2: services to help people find and access
treatment, care and support and, in Area Mental Health and
Wellbeing Services, respond to crises 24 hours a day, seven days
a week.
c. Core function 3: support for primary and secondary care and
related services through primary consultation with consumers,
secondary consultation with providers of those services and a
formal model of comprehensive shared care.

2. commission and ensure that Adult and Older Adult Local Mental
Health and Wellbeing Services and Adult and Older Adult Area
Mental Health and Wellbeing Services referred to in recommendation
3(2)(a) and (b) work in collaboration to deliver multidisciplinary,
holistic and integrated treatment, care and support through a range
of delivery modes including:
a. site-based care (such as centres or clinics);
b. telehealth;
c. digital technologies; and
d. visits to people’s homes and other places (including targeted
assertive outreach).

3. ensure Adult and Older Adult Local Mental Health and Wellbeing
Services and Adult and Older Adult Area Mental Health and
Wellbeing Services are accessible and responsive to the diversity of
local communities.

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Recommendation 6:

Helping people find and access treatment, care and support

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. ensure people can access Local Mental Health and Wellbeing

Services through a referral from a general practitioner or any other
service provider, or through a discussion with the relevant service’s
access and navigation support worker.

2. ensure people can access Area Mental Health and Wellbeing

Services through a referral from a Local Mental Health and Wellbeing
Service or through direct referral from a medical practitioner.

3. ensure people can access Statewide Mental Health and Wellbeing

Services through a referral from an Area Mental Health and
Wellbeing Service.

4. promote, and co-produce with people with lived experience, a

website that provides clear, up-to-date information about Victoria’s
mental health and wellbeing system that helps users to:
a. understand their mental health needs;
b. identify services and supports across all relevant provider types;
and
c. access online self-help resources.

5. collaborate with its funded non-government helpline services to

improve helplines’ connections with mental health and wellbeing
services and to assist people to find and access treatment, care and
support.

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Recommendation 7:

Identifying needs and providing initial support

in mental health and wellbeing services

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. ensure mental health and wellbeing services provide three ‘needs

identification and initial support’ functions:
a. access and navigation support;
b. initial support discussions; and
c. comprehensive needs assessment and planning discussions.

2. ensure these functions are delivered based on a philosophy of ‘how

can we help?’ to enable people to be supported from their first to
their last contact with mental health and wellbeing services.

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Recommendation 8:

Responding to mental health crises

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. ensure each Adult and Older Adult Area Mental Health and
Wellbeing Service delivers a centrally coordinated 24-hours-a-day
telephone/telehealth crisis response service accessible to both
service providers and to members of the community of all ages that
provides:
a. crisis assessment and immediate support;
b. mobilisation of a crisis outreach team or emergency service
response where necessary; and
c. referral for follow-up by mental health and wellbeing services
and/or other appropriate services.

2. expand crisis outreach services in each Adult and Older Adult Area
Mental Health and Wellbeing Service to provide treatment, care
and support from a clinician and nonclinical worker such as a peer
worker.

3. improve emergency departments’ ability to respond to mental

health crises by:
a. establishing a classification framework for all emergency
departments and urgent care centres, based on their capability
to respond to people experiencing mental health crises;

b. using the classification framework to ensure that health services

are appropriately resourced to perform their role in a regional
network of emergency departments and urgent care centres; and

c. ensuring there is at least one highest-level emergency

department suitable for mental health and alcohol and other
drug treatment in each region.

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Recommendation 9:

Developing ‘safe spaces’ and crisis respite facilities

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. invest in diverse and innovative ‘safe spaces’ and crisis respite

facilities for the resolution of mental health and suicidal crises which
are consumer-led and, where appropriate, delivered in partnership
with non-government organisations.

2. in collaboration with the new agency led by people with lived

experience of mental illness or psychological distress (refer to
recommendation 29) and non-government organisations that deliver
wellbeing supports, establish:
a. one drop-in or crisis respite facility for adults and older Victorians
per region (refer to recommendation 3(3)); and

b. four safe space facilities across the state, comprising a mix of

drop-in spaces and crisis response services, co-designed with
and for young people.

3. establish a crisis stabilisation facility, in consultation with people

with lived experience, led by a public health service or public hospital
in partnership with a non-government organisation that delivers
wellbeing supports.

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Recommendation 10:

Supporting responses from emergency

services to mental health crises

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. ensure that, wherever possible, emergency services’ responses to

people experiencing time-critical mental health crises are led by
health professionals rather than police.

2. support Ambulance Victoria, Victoria Police and the Emergency

Services Telecommunications Authority to work together to revise
current protocols and practices such that, wherever possible and safe:
a. Triple Zero (000) calls concerning mental health crises are
diverted to Ambulance Victoria rather than Victoria Police; and
b. responses to mental health crises requiring the attendance of
both ambulance and police are led by paramedics (with support
from mental health clinicians where required).

3. ensure that mental health clinical assistance is available to

ambulance and police via:
a. 24-hours-a-day telehealth consultation systems for officers
responding to mental health crises;
b. in-person co-responders in high-volume areas and time periods;
and
c. diversion secondary triage and referral services for Triple Zero
(000) callers who do not require a police or ambulance dispatch.

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Recommendation 11:

New models of care for bed‑based services

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. review, reform and implement new models of multidisciplinary care

for bed-based services that are delivered in a range of settings,
including in a person’s home and in fit-for-purpose community and
hospital environments.

2. deliver a broad range of bed-based services, including as a matter of

immediate priority:
a. expanding Hospital in the Home services as an alternative
to acute hospital-based treatment, care and support where
appropriate;

b. investing in a wide range of time-limited and flexible residential

respite services informed by local priorities, including establishing
a peer-led residential respite service at a demonstration site; and

c. developing new bed-based rehabilitation services (refer to

recommendation 12).

3. build on the interim report’s recommendation 2 about the need for

the expansion of acute mental health services and deliver at least
100 additional beds in settings that reflect optimal allocation and
distribution across Victoria.

4. periodically review the allocation of new beds as part of the

statewide and regional planning processes recommended by the
Royal Commission (refer to recommendation 47) and audit the
outcomes.

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Recommendation 12:

Developing new bed-based rehabilitation services

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. implement the new whole-of-system rehabilitation pathway

described by the Royal Commission in its final report, which includes
two new bed-based rehabilitation models of care, for people living
with mental illness who require ongoing intensive treatment, care
and support.

2. consistent with the ‘design and quality features’ described by the

Royal Commission in its final report, co-design with consumers,
clinicians and relevant non-government organisations and services:
a. the new community rehabilitation model of care and deliver it at a
community care unit demonstration site; and

b. the new intensive rehabilitation model of care and deliver it at a

secure extended care unit demonstration site.

3. subject to the evaluation and required adaptation of the new

rehabilitation models of care, apply these models to existing
community care and secure extended care units and enhance and
expand infrastructure accordingly.

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Recommendation 13:

Addressing gender-based violence in mental health facilities

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. ensure that all new mental health inpatient facilities:

a. are built and designed with the necessary scale and flexible
infrastructure to enable gender-based separation in all bedrooms
and bathrooms; and
b. provide separate communal spaces as required.

2. by mid-2022, ensure that existing high dependency units in inpatient

facilities allow for gender-based separation.

3. review and retrofit existing inpatient facilities on a case-by-case

basis to:
a. achieve gender-based separation where possible; and
b. as a matter of priority, ensure that each facility meets the
minimum standards for gender safety set out in the Chief
Psychiatrist’s guideline: Promoting sexual safety, responding to
sexual activity and managing allegations of sexual assault in
adult acute inpatient units.

4. ensure that the Mental Health and Wellbeing Division supports

mental health and wellbeing services to eliminate sexual and
gender-based violence in bed-based service settings.

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Recommendation 14:

Supporting mental health consultation liaison services

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. work with the Independent Hospital Pricing Authority and the

Commonwealth Government to:
a. ensure mental health consultation liaison services for consumers
admitted for physical health reasons are formally recognised and
adequately funded as part of routine care; and
b. ensure mental health consultation liaison services are
incorporated, costed and priced in the relevant classifications
and standards.

2. ensure public health services and public hospitals:

a. receive adequate temporary funding to embed and deliver
in-hospital mental health consultation liaison services as part
of routine care until joint funding arrangements between the
Commonwealth and Victorian governments are established;

b. are accountable for delivering in-hospital mental health

consultation liaison services and, whenever required, provide such
services to consumers admitted for physical health reasons; and

c. are accountable for providing the sustained delivery of

high‑quality integrated mental health treatment, care and
support across the hospital system.

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Recommendation 15:

Supporting good mental health

and wellbeing in local communities

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. establish and recurrently resource ‘community collectives’ for mental

health and wellbeing in each local government area.

2. support each community collective to bring together a diversity of

local leaders and community members to guide and lead efforts to
promote social connection and inclusion in Victorian communities.

3. test and develop a range of initiatives that support community

participation, inclusion and connection.

4. by the end of 2022, establish one social prescribing trial per

region (refer to recommendation 3(3)) in Local Mental Health and
Wellbeing Services to support healthcare professionals to refer
people, particularly older Victorians, living with mental illness, into
community initiatives.

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Recommendation 16:

Establishing mentally healthy workplaces

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. as an initiative of the Mental Health and Wellbeing Cabinet

Subcommittee (refer to recommendation 46(2)(a)):
a. foster the commitment of employers to create mentally healthy
workplaces;
b. advise on, develop and provide resources to assist employers and
employees across Victorian businesses to:
• promote good mental health in workplaces;
• address workplace barriers to good mental health;
• promote inclusive workplaces that are free from stigma and
discrimination; and
• support people experiencing mental illness at work.

2. sponsor industry-based trials to demonstrate how to adapt and

implement comprehensive mentally healthy workplace approaches
in an industry context.

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Recommendation 17:

Supporting social and emotional wellbeing in schools

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. fund evidence-informed initiatives, including anti-stigma and anti-

bullying programs, to assist schools in supporting students’ mental
health and wellbeing.

2. develop a digital platform that contains a validated list of these

initiatives.

3. develop a fund, modelled on School Readiness Funding for

kindergartens, to support schools, with priority given to those in rural
and regional areas, to select the most appropriate suite of initiatives
for them.

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Recommendation 18:

Supporting the mental health and

wellbeing of prospective and new parents

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. expand and reform the community perinatal mental health teams

in each Adult and Older Adult Area Mental Health and Wellbeing
Service across Victoria to adapt and deliver the core functions as
set out in recommendation 5, including by providing consultation to
primary and secondary care and related services for prospective
and new parents, including maternal and child health nurses.

2. review approaches to perinatal mental health screening.

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Recommendation 19:

Supporting infant, child and family mental health and wellbeing

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. establish one responsive and integrated infant, child and youth

mental health and wellbeing system to provide developmentally
appropriate mental health and wellbeing treatment, care and
support for newborns to 25-year-olds.

2. by the end of 2022, establish a dedicated service stream for infants,

children and their families, consisting of Infant, Child and Family
Area Mental Health and Wellbeing Services, within the 13 Infant,
Child and Youth Area Mental Health and Wellbeing Services (refer to
recommendation 3(2)(c)) to:
a. provide developmentally appropriate mental health and wellbeing
treatment, care and support services for newborns to 11-year-olds
and their families; and
b. adapt and deliver the core functions of community mental health
and wellbeing services (refer to recommendation 5), including
through a range of delivery modes, ensuring services are
accessible and responsive to the diversity of local communities.

3. by the end of 2022, and in partnership with the Commonwealth,

establish three infant, child and family health and wellbeing
multidisciplinary community-based hubs.

4. deliver evidence-informed online parenting programs and

group‑based parenting sessions.

5. establish two statewide subacute residential family admission

centres located in the community.

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Recommendation 20:

Supporting the mental health and wellbeing of young people

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. by the end of 2022, establish a dedicated service stream for young

people, consisting of Youth Area Mental Health and Wellbeing
Services, within the 13 Infant, Child and Youth Area Mental Health
and Wellbeing Services (refer to recommendation 3(2)(c)) to:
a. appropriately adapt and deliver the core functions of
community mental health and wellbeing services set out in
recommendation 5, including through a range of delivery modes
and ensuring services are accessible and responsive to the
diversity of local communities; and
b. provide both short-term and ongoing treatment, care and
support to young people, including those who require ongoing
intensive treatment, care and support.

2. ensure Youth Area Mental Health and Wellbeing Services are

available for young people aged 12 to 25 (until a person’s 26th
birthday), with age boundaries and transitions to be applied flexibly
by services in partnership with young people and their families,
carers and supporters.

3. support the development of formal partnerships, step-up and

step-down referral pathways, shared staff and infrastructure and
co-location between headspace centres and Infant, Child and Youth
Area Mental Health and Wellbeing Services.

4. work with the Commonwealth Government, headspace National

and Primary Health Networks to ensure that Infant, Child and Youth
Area Mental Health and Wellbeing Services become the preferred
providers of headspace centres where they exist or are established
in Victoria.

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Recommendation 21:

Redesigning bed-based services for young people

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. review, reform and implement new models of multidisciplinary care

for bed-based services for young people that are delivered in a
range of settings, including in young people’s homes and in fit-for-
purpose community and hospital environments.

2. deliver a broad range of bed-based services, including as a matter of

immediate priority:
a. ensuring every region has a Youth Prevention and Recovery
Centre for young people aged 16 to 25, supported through a
common and consistent model of care;

b. creating a new stream of inpatient beds across Victoria for young

people aged 18 to 25 by reconfiguring existing inpatient beds for
adults and using an allocation of the 100 new beds referred to in
recommendation 11(3); and

c. ensuring Hospital in the Home services are available for young

people as an alternative to acute hospital-based treatment, care
and support where appropriate.

3. formally review the Youth Residential Rehabilitation Program in

consultation with young people, as well as families, carers and
supporters.

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Recommendation 22:

Supporting the mental health and wellbeing of older Victorians

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. establish a responsive and integrated mental health and wellbeing

service stream for older Victorians that focuses on improving their
mental health and wellbeing outcomes.

2. ensure older Victorians have access to the same mental health

treatment, care and support as the rest of the adult population.

3. establish older adult mental health and wellbeing specialist

multidisciplinary teams in Adult and Older Adult Area Mental Health
and Wellbeing Services (refer to recommendation 3(2)(b)), to:
a. provide specialist mental health treatment, care and support
for people with complex and compounding mental health needs
generally related to ageing; and
b. assist primary and secondary care and related services that
support older Victorians, including aged care, through primary
consultation, secondary consultation and shared care.

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Recommendation 23:

Establishing a new Statewide Trauma Service

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. by the end of 2022, establish a Statewide Trauma Service hosted

within the Collaborative Centre for Mental Health and Wellbeing, to
deliver the best possible mental health and wellbeing outcomes for
people of all ages with lived experience of trauma.

2. fund the Statewide Trauma Service to bring together mental health

practitioners, trauma experts, peer workers and consumers with
lived experience of trauma to:
a. conduct multidisciplinary and translational trauma research;
b. develop and deliver education and training that supports
Victoria’s mental health and wellbeing workforce to deliver
trauma-informed care;
c. develop and oversee digital peer-led support platforms offering
consumers access to peer support networks; and
d. coordinate and facilitate access to specialist trauma expertise,
including secondary consultation for mental health practitioners
and peer workers across Victoria’s mental health and wellbeing
system.

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Recommendation 24:

A new approach to addressing trauma

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. in collaboration with the Statewide Trauma Service (refer to

recommendation 23), enable each of the 22 Adult and Older Adult
Area Mental Health and Wellbeing Services and each of the 13 Infant,
Child and Youth Area Mental Health and Wellbeing Services (refer
to recommendation 3(2)(b) and (c)) to employ up to three specialist
trauma practitioners to:
a. work with peer support workers in Local Mental Health and
Wellbeing Services to provide and facilitate access to a broad
range of trauma supports for consumers of all ages and
backgrounds; and
b. contribute to the ongoing learning and professional development
of the mental health and wellbeing workforce through supervision,
consultation and shared clinical care.

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Recommendation 25:

Supported housing for adults and

young people living with mental illness

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. recognise people who are living with mental illness as a priority

population group as part of Victoria’s 10-year strategy for social and
affordable housing and ensure that, during the next decade, people
living with mental illness are allocated a continuing substantial
proportion of social and affordable housing.

2. revise the Victorian Housing Register’s Special Housing Needs

‘priority access’ categories to include people living with mental
illness, including people who need ongoing intensive treatment, care
and support.

3. ensure that the 2,000 dwellings assigned to Victorians living with

mental illness in the Big Housing Build are delivered as supported
housing and are prioritised for people living with mental illness who
require ongoing intensive treatment, care and support, with Area
Mental Health and Wellbeing Services assisting with the selection
process.

4. in addition to the 2,000 dwellings, invest in a further 500 new

medium-term (up to two years) supported housing places for young
people aged between 18 to 25 who are living with mental illness and
experiencing unstable housing or homelessness.

5. ensure that the supported housing homes for adults and young
people living with mental illness are:
a. delivered in a range of housing configurations including
standalone units, self-contained units with shared amenities and
various forms of clustered independent units on a single-site
property;
b. appropriately located, provide for the requirements of people
living with mental illness and are co-designed by Homes Victoria,
representatives appointed by the Mental Health and Wellbeing
Division and people with lived experience of mental illness; and
c. accompanied by an appropriate level of integrated,
multidisciplinary and individually tailored mental health and
wellbeing treatment, care and support.

6. periodically review the allocation of supported housing homes as

part of the statewide and regional planning processes recommended
by the Royal Commission (refer to recommendation 47) and audit
the outcomes.

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Recommendation 26:

Governance arrangements for

suicide prevention and response efforts

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. establish in the Mental Health and Wellbeing Division, a Suicide

Prevention and Response Office, led by a State Suicide Prevention
and Response Adviser who reports to the Chief Officer for Mental
Health and Wellbeing (refer to recommendation 45(1)).

2. enable the Suicide Prevention and Response Office to:

a. establish a system-based approach to suicide prevention and
response efforts;
b. work with people with lived experience of suicidal behaviour,
family members and carers, and people with lived experience of
bereavement by suicide to co-produce, implement and monitor a
new suicide prevention and response strategy for Victoria;
c. work closely with the Commonwealth Government to ensure
suicide prevention and response efforts in Victoria are
coordinated with, and complement, national approaches;
d. facilitate a community-wide and government-wide approach to
suicide prevention and response efforts;
e. work within governance structures that encompass all
government departments and relevant agencies, with Deputy
Secretary and Secretary-level membership; and
f. employ people with lived experience of suicidal behaviour,
family members and carers, and people with lived experience of
bereavement by suicide.

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Recommendation 27:

Facilitating suicide prevention and response initiatives

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. build on the interim report’s recommendation 3 on suicide

prevention and response and develop initiatives to support people
experiencing suicidal behaviour including:
a. providing training in appropriate responses for members of
workforces likely to come into contact with people experiencing
suicidal behaviour;
b. providing free, online, evidence-informed ‘community gatekeeper
training’ for Victorians to develop suicide awareness and
prevention skills;
c. enabling Aboriginal people to design culturally safe ‘community
gatekeeper training’ for Aboriginal people; and
d. facilitating Victorian industries and businesses to invest in
evidence-informed workplace suicide prevention and response
programs, with an initial focus on forming partnerships with
high‑risk industries.

2. develop initiatives to support people at risk of experiencing suicidal

behaviour, by:
a. co-producing an aftercare service for lesbian, gay, bisexual,
trans and gender diverse, intersex, queer and questioning people
following a suicide attempt; and

b. in partnership with the Commonwealth Government,

implementing statewide postvention bereavement support, so
that every person bereaved by suicide is automatically referred to
a postvention bereavement provider.

3. develop an intensive 14-day support program for adults who are

experiencing psychological distress, modelled on Scotland’s Distress
Brief Intervention program

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Recommendation 28:

Developing system-wide roles for the full and effective

participation of people with lived experience of mental
illness or psychological distress

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. in addition to the nominated roles specified in other

recommendations, develop key roles across the mental health and
wellbeing system for people with lived experience of mental illness or
psychological distress.

2. enable the Mental Health and Wellbeing Commission (refer to

recommendation 44) to:
a. elevate the leadership and support the full and effective
participation of people with lived experience of mental illness
or psychological distress in decision-making about policies and
programs, including those directly affecting them;
b. develop and support the leadership capabilities of people with
lived experience of mental illness or psychological distress
through learning and development opportunities;
c. design and deliver initiatives to prevent and address stigma
towards people living with mental illness or psychological distress;
and
d. design and deliver initiatives to develop awareness and
understanding of the experiences and perspectives of people with
lived experience of mental illness or psychological distress.

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Recommendation 29:

A new agency led by people with lived experience

of mental illness or psychological distress

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. build on the interim report’s recommendation 5 and establish a new

non-government agency, overseen by a skills-based board chaired
by and consisting of a majority of people with lived experience of
mental illness or psychological distress, to:

a. deliver accredited training and resources to aid the development

of organisations led by people with lived experience of mental
illness or psychological distress;

b. develop and deliver mental health and wellbeing services led by

people with lived experience of mental illness or psychological
distress; and

c. facilitate co-location, shared resourcing, learning opportunities

and the creation of new partnerships and networks between
people with lived experience of mental illness or psychological
distress and the organisations they lead.

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Recommendation 30:

Developing system‑wide involvement

of family members and carers

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. in addition to the nominated roles specified in other

recommendations, develop key roles across the mental health and
wellbeing system for people with lived experience as family members
and carers.

2. enable the Mental Health and Wellbeing Commission (refer to

recommendation 44) to:
a. elevate the leadership and promote the valued role of family
members and carers of people living with mental illness or
psychological distress throughout the mental health and
wellbeing system; and
b. develop and support the leadership and governance capabilities
of families and carers of people living with mental illness or
psychological distress through learning and development
opportunities.

3. ensure that:
a. in commissioning mental health and wellbeing services,
expectations are set for working with families, carers and
supporters;
b. families, carers and supporters are included in a range of
therapeutic interventions in each Area Mental Health and
Wellbeing Service; and
c. working with families, carers and supporters is part of
system‑wide workforce training.

4. in addition to reforms to improve information sharing outlined

in other recommendations, develop standards for services and
practitioners to guide the sharing of appropriate information with
families, carers and supporters.

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Recommendation 31:

Supporting families, carers and supporters

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. by the end of 2022, commission non-government organisations to

use consistent branding and deliver one family and carer-led centre
in each of the eight regions (refer to recommendation 3(3)) to:
a. provide tailored information and supports for families, carers and
supporters in the region;
b. work with families, carers and supporters to help identify their
needs and connect them to the supports that will best respond to
those needs;
c. provide access to increased funds for immediate practical needs
including short-term respite (brokerage); and
d. deliver support for family and carer peer support groups in the
region.

2. establish a statewide peer call-back service for families, carers and

supporters caring for people experiencing suicidal behaviour.

3. ensure there is tailored information for families, carers and

supporters, such as on the new statewide mental health website
(refer to recommendation 6(4)).

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Recommendation 32:

Supporting young carers

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. by the end of 2022, fund a non-government organisation such as the

Satellite Foundation to co-design and expand the range of supports
across Victoria for young carers and children and young people who
have a family member living with mental illness or psychological
distress.

2. by the end of 2022, broaden the scope and reach of the Families
where a Parent has a Mental Illness program, including by:
a. enabling each Area Mental Health and Wellbeing Service to
employ new workers to support young carers in their local
environment; and

b. increasing the funding available to young carers to help with

practical needs (brokerage).

3. strengthen identification and referral pathways for young carers

through the mental health and education systems.

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Recommendation 33:

Supporting Aboriginal social and emotional wellbeing

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. build on the interim report’s recommendation 4 to support

Aboriginal social and emotional wellbeing, and resource the Social
and Emotional Wellbeing Centre to establish two co-designed
healing centres.

2. resource Infant, Child and Youth Area Mental Health and Wellbeing
Services to support Aboriginal community-controlled health
organisations by providing primary consultation, secondary
consultation and shared care.

3. resource Aboriginal community-controlled health organisations to

commission the delivery of culturally appropriate, family-oriented,
social and emotional wellbeing services for children and young
people.

4. resource the Victorian Aboriginal Community Controlled Health

Organisation, in partnership with an Infant, Child and Youth Area
Mental Health and Wellbeing Service, to design and establish a
culturally appropriate, family-oriented service for infants and
children who require intensive social and emotional wellbeing
supports.

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Recommendation 34:

Working in partnership with and improving

accessibility for diverse communities

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. ensure the active engagement of Victoria’s diverse communities

throughout the process of planning, implementing and managing
the reformed mental health and wellbeing system.

2. legislatively provide that the Secretary of the Department of Health

is responsible for the delivery of a mental health and wellbeing
system that responds to the needs of Victoria’s diverse communities
and promotes access and equity of outcomes, with this function able
to be delegated to the Chief Officer for Mental Health and Wellbeing
(refer to recommendation 45(1)).

3. ensure that the Mental Health and Wellbeing Division:

a. collects, analyses and reports on data on the mental health and
wellbeing of Victoria’s diverse communities for planning and
funding purposes and to improve transparency in mental health
and wellbeing outcomes for diverse communities;

b. ensures that Victorians, regardless of first or preferred language,

hearing, literacy or neurocognitive ability, have access to
appropriate mental health and wellbeing information and means
of communication throughout the mental health and wellbeing
system;

c. enables Victoria’s diverse communities and community-led

organisations to:
• design and deliver mental health and wellbeing information
and awareness campaigns; and
• assist their communities to navigate the mental health and
wellbeing system.

4. by the end of 2021, provide recurrent funding to Switchboard Victoria

to deliver its Rainbow Door program, at scale, to support people who
identify as lesbian, gay, bisexual, trans and gender diverse, intersex,
queer and questioning to navigate and access the mental health
and wellbeing system.

5. enable the development of digital technologies to support the

delivery of language services that assist access to and engagement
with mental health and wellbeing services.

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Recommendation 35:

Improving outcomes for people living with

mental illness and substance use or addiction

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. by the end of 2022, in addition to ensuring there is at least one

highest-level emergency department suitable for mental health
and alcohol and other drug treatment in every region (refer to
recommendations 3(3) and 8(3)(c)), ensure that all mental health and
wellbeing services, across all age-based systems, including crisis
services, community-based services and bed-based services:
a. provide integrated treatment, care and support to people living
with mental illness and substance use or addiction; and

b. do not exclude consumers living with substance use or addiction

from accessing treatment, care and support.

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Recommendation 36:

A new statewide service for people living with

mental illness and substance use or addiction

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. establish a new statewide specialist service, built on the foundations

established by the Victorian Dual Diagnosis Initiative, to:
a. undertake dedicated research into mental illness and substance
use or addiction;
b. support education and training initiatives for a broad range
of mental health and alcohol and other drug practitioners and
clinicians;
c. provide primary consultation to people living with mental illness
and substance use or addiction who have complex support needs;
and
d. provide secondary consultation to mental health and wellbeing
and alcohol and other drug practitioners and clinicians across
both sectors.

2. as a matter of priority, increase the number of addiction specialists

(addiction medicine physicians and addiction psychiatrists) in
Victoria.

3. work with the Commonwealth Government to explore opportunities

for funded addiction specialist trainee positions in Victoria.

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Recommendation 37:

Supporting the mental health and wellbeing of people

in contact with, or at risk of coming into contact with,
the criminal and youth justice systems

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. expand the Assessment and Referral Court to each of the 12

headquarter Magistrates’ Courts to meet demand at both existing
and new locations.

2. expand the existing forensic community model to:

a. enable Adult and Older Adult Area Mental Health and Wellbeing
Services and Infant, Child and Youth Area Mental Health and
Wellbeing Services (refer to recommendation 3(2)(b) and (c)) to
provide consistency in treatment, care and support to people in
contact with, or at risk of coming into contact with, the criminal
justice system; and
b. establish the specialist behaviour response team described by
the Royal Commission in its final report.

3. establish a program for people in prison living with mental illness

who require ongoing intensive treatment, care and support to
transition the delivery of supports from correctional settings to the
mainstream mental health and wellbeing system upon their release.

4. expand specialist youth forensic mental health programs to a

statewide model, including across the 13 Infant, Child and Youth Area
Mental Health and Wellbeing Services (refer to recommendation
3(2)‌(c)), to provide consistent and appropriately specialised
treatment, care and support to children and young people in contact
with, or at risk of coming into contact with, the youth justice system.

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Recommendation 38:

Providing safe and appropriate mental health treatment,

care and support at Thomas Embling Hospital

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. in line with master planning for Thomas Embling Hospital and the
proposal of the Victorian Health and Human Services Building
Authority:
a. refurbish the existing 136 beds; and
b. by the end of 2026, provide an additional 107 beds, a small number
of which should be allocated for people living with mental illness
whose treatment, care and support requirements cannot be safely
and appropriately met in acute inpatient settings or through the
forensic community model (refer to recommendation 37(2)).

2. provide up to 20 beds, in addition to the 107 beds referred

to in recommendation 38(1) (b) and the additional beds in
recommendation 11(3), to support people living with mental illness
whose treatment, care and support requirements cannot be, or
are unlikely to be, safely and effectively met in other extended
rehabilitation settings.

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Recommendation 39:

Supporting the mental health and wellbeing

of people in rural and regional Victoria

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. in addition to ensuring rural and regional communities receive the

benefits of the Royal Commission’s recommended responsive and
integrated mental health and wellbeing system:
a. provide additional resources to enable mental health and
wellbeing services operating in regional Victoria to deliver services
to small or geographically isolated rural communities; and

b. by the end of 2022, trial two new digital service delivery initiatives
in rural and regional areas that meet the needs of local
communities.

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Recommendation 40:

Providing incentives for the mental health and

wellbeing workforce in rural and regional areas

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. address mental health and wellbeing workforce supply needs in rural

and regional areas and establish an incentive scheme to:
a. attract mental health and wellbeing workers to rural and regional
mental health and wellbeing services; and
b. retain mental health and wellbeing workers in such services.

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Recommendation 41:

Addressing stigma and discrimination

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. fund and support the Mental Health and Wellbeing Commission

(refer to recommendation 44) to work with a network of partners,
including research organisations, to lead the design and delivery of
anti-stigma programs that:
a. continue on a long-term basis; and
b. aim to reduce the impact of stigma in a range of settings
including, but not limited to, healthcare settings, workplaces
and schools.

2. design and deliver an anti-stigma grants program to:

a. support community-led organisations and community members
to deliver projects that challenge stigma in Victorian settings and
communities; and
b. focus, as an immediate priority, on communities and social
groups at increased risk of stigma.

3. conduct a comprehensive evaluation of anti-stigma efforts to:

a. develop evidence about effective ways to address mental health
stigma across Victoria; and
b. inform the design and delivery of anti-stigma programs.

4. support and establish mechanisms to:

a. address systemic issues of mental health discrimination;
b. enhance individual access to legal protection from mental health
discrimination; and
c. enable one or two independent legal services with a
demonstrated connection or ability to connect with people with
lived experience of mental illness or psychological distress to
initiate legal claims, including test cases relating to systemic
mental health discrimination.

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Recommendation 42:

A new Mental Health and Wellbeing Act

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. repeal the Mental Health Act 2014 (Vic) and enact a new Mental
Health and Wellbeing Act, preferably by the end of 2021 and no later
than mid-2022, to:
a. promote good mental health and wellbeing;
b. reset the legislative foundations underpinning the mental health
and wellbeing system; and
c. support the delivery of services that are responsive to the needs
and preferences of Victorians.

2. ensure the Mental Health and Wellbeing Act:

a. includes new objectives and mental health principles, with its
primary objective to achieve the highest attainable standard of
mental health and wellbeing for the people of Victoria by:
• promoting conditions in which people can experience good
mental health and wellbeing;
• reducing inequities in access to, and the delivery of, mental
health and wellbeing services; and
• providing a diverse range of comprehensive, safe and high-
quality mental health and wellbeing services.
b. clarifies the roles, responsibilities and governance arrangements
of the new mental health and wellbeing system;
c. establishes the bodies and roles referred to in other
recommendations, including the Mental Health and Wellbeing
Commission (refer to recommendation 44), the Chief Officer for
Mental Health and Wellbeing (refer to recommendation 45(1))
and Regional Mental Health and Wellbeing Boards (refer to
recommendation 4(2));
d. strengthens accountability mechanisms and monitoring
arrangements for service delivery;
e. specifies measures to reduce rates and negative impacts of
compulsory assessment and treatment, seclusion and restraint;
f. simplifies and clarifies the statutory provisions relating to
compulsory assessment and treatment such that they are no
longer the defining feature of Victoria’s mental health laws; and
g. specifies the ways in which information about mental health and
wellbeing may be collected and used.

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Recommendation 43:

Future review of mental health laws

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. commission an independent review of Victoria’s mental health laws

five to seven years after the enactment of the Mental Health and
Wellbeing Act.

2. co-design terms of reference for the review that focus on ensuring

mental health laws remain contemporary, effective and responsive
to the needs and preferences of consumers, families, carers and
supporters.

3. as part of this review, consider the role and functions of the Mental
Health Tribunal and Chief Psychiatrist to ensure they remain
appropriate.

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Recommendation 44:

A new Mental Health and Wellbeing Commission

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. establish an independent statutory authority, the Mental Health and

Wellbeing Commission, to:
a. hold government to account for the performance and quality and
safety of the mental health and wellbeing system;
b. support people living with mental illness or psychological distress,
families, carers and supporters to lead and partner in the
improvement of the system;
c. monitor the Victorian Government’s progress in implementing the
Royal Commission’s recommendations; and
d. address stigma related to mental health.

2. ensure the Mental Health and Wellbeing Commission:

a. is led by a Chair Commissioner and who is supported by a small
group of Commissioners, all of whom are appointed by the
Governor-in-Council; and
b. includes at least one Commissioner with lived experience of
mental illness or psychological distress and one Commissioner
with lived experience as a family member or carer.

3. enable the Mental Health and Wellbeing Commission to:

a. obtain data and information about mental health and wellbeing
service delivery, system performance and outcomes, and other
relevant information, from all government agencies;
b. work with and share data and information with the Department of
Health and other relevant entities (for example, the Collaborative
Centre for Mental Health and Wellbeing and Safer Care Victoria);
c. initiate its own inquiries into matters that support its objectives;
d. handle and investigate complaints about mental health and
wellbeing service delivery;
e. make recommendations to the Premier, any minister and the
heads of public service bodies; and
f. publish reports on the performance and quality and safety of the
mental health and wellbeing system.

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Recommendation 45:

Effective leadership of and accountability

for the mental health and wellbeing system

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. establish in legislation the role of Chief Officer for Mental Health and
Wellbeing to lead the Mental Health and Wellbeing Division in the
Department of Health, and set out in that legislation that this Chief
Officer is:
a. delegated the functions and powers conferred on the Secretary
of the Department of Health under the new Mental Health and
Wellbeing Act (refer to recommendation 42);
b. appointed by and reports to the Secretary; and
c. at the level of a Deputy Secretary.

2. empower the Chief Officer to take responsibility for the

implementation of the Royal Commission’s recommendations, unless
otherwise stated in these recommendations.

3. transfer the functions of Mental Health Reform Victoria (which was

established pursuant to the interim report’s recommendation 9) to
the division by mid-2021.

4. ensure that the division employs people with lived experience

of mental illness or psychological distress and people with lived
experience of caring for someone living with mental illness in
multiple, substantive positions, including leadership positions.

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Recommendation 46:

Facilitating government‑wide efforts

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. establish governance structures to:

a. facilitate government-wide and community-wide approaches to
improving mental health and wellbeing; and
b. oversee the implementation of the Royal Commission’s
recommendations.

2. ensure these governance structures comprise:

a. a Mental Health and Wellbeing Cabinet Subcommittee, chaired by
the Premier for at least two years;
b. a Mental Health and Wellbeing Secretaries’ Board, chaired by
the Department of Premier and Cabinet and comprising: the
Secretaries of the Department of Health, the Department of
Families, Fairness and Housing, the Department of Education
and Training, the Department of Justice and Community Safety
and the Department of Treasury and Finance, as well as the Chief
Officer for Mental Health and Wellbeing;
c. a Suicide Prevention and Response Secretaries’ Board
Subcommittee, co-chaired by the Department of Premier and
Cabinet and the Department of Health, attended and supported
by the State Suicide Prevention and Response Adviser (refer to
recommendation 26(1)) and comprising all state government
departments and relevant agencies, with Deputy Secretary and
Secretary-level membership; and
d. an Interdepartmental Committee on Mental Health and Wellbeing
Promotion, co-chaired by the Department of Premier and
Cabinet and the Department of Health, attended and supported
by the Mental Health and Wellbeing Promotion Adviser (refer
to recommendation 2(1)) and comprising all state government
departments and relevant agencies, with Deputy Secretary-level
membership.

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Recommendation 47:

Planning the new mental health and wellbeing system

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. establish a process for assessing the Victorian population’s need for

mental health and wellbeing services by initially using a substantially
adjusted version of the National Mental Health Service Planning
Framework.

2. develop and publish a statewide mental health and wellbeing service

and capital plan and eight regional mental health and wellbeing
service and capital plans, with the first plans to be endorsed by
the Mental Health and Wellbeing Secretaries’ Board (refer to
recommendation 46(2)(b)) by the end of 2022, with the remainder
approved by the end of 2023.

3. update the statewide mental health and wellbeing service and

capital plan every three years.

4. by no later than the end of 2026, empower Regional Mental Health

and Wellbeing Boards (refer to recommendation 4(2)) to update
regional mental health and wellbeing service and capital plans every
three years.

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Recommendation 48:

Selecting providers and resourcing services

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. build on the interim report’s recommendation 8 regarding

a new approach to mental health investment and use, and
empower Regional Mental Health and Wellbeing Boards (refer to
recommendation 4(2)) to use, new service standards developed
by the Royal Commission to select providers of mental health
and wellbeing services, including new providers and provider
partnerships.

2. support the further development of new and existing providers to

meet the long-term ambition of the service standards.

3. develop new ways of funding providers that encourage the provision

of mental health and wellbeing services that consumers, families,
carers and supporters value and result in an equitable allocation of
resources through:
a. trialling then implementing an activity-based funding model
for both bed-based and community-based mental health and
wellbeing services;

b. working with the Collaborative Centre for Mental Health and

Wellbeing to develop and implement an approach to bundling
funding into one price for an evidence-informed pathway that is
linked to improving outcomes; and

c. developing and trialling a capitation funding model that provides

a tailored package for consumers, families, carers and supporters.

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Recommendation 49:

Monitoring and improving mental

health and wellbeing service provision

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. establish a new performance monitoring and accountability

framework to:
a. hold, and empower Regional Mental Health and Wellbeing
Boards (refer to recommendation 4(2)) to hold, mental health and
wellbeing service providers to account and improve performance
over time;
b. improve the outcomes and experiences of consumers, families,
carers and supporters; and
c. measure the effectiveness of mental health and wellbeing
services from the perspectives of consumers, families, carers and
supporters.

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Recommendation 50:

Encouraging national partnerships

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. work with the Commonwealth Government and the National Cabinet

Reform Committee to:
a. delineate the responsibilities of governments in providing a
structured, coordinated, long-term approach to planning,
investment and reform through the new National Mental Health
and Suicide Prevention Agreement;
b. raise the profile of:
• mental health and wellbeing, and suicide prevention and
response services;
• associated supports such as housing and homelessness
services; and
• lived experience leadership.
c. ensure a strong focus on the implementation of mental health
and wellbeing strategies.

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Recommendation 51:

Commissioning for integration

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. build on new ways of resourcing and monitoring mental health

and wellbeing services (refer to recommendations 48 and 49) and
empower Regional Mental Health and Wellbeing Boards (refer to
recommendation 4(2)) to:
a. commission one demonstration project in each region (refer to
recommendation 3(3)) in which a provider or providers deliver
multiple services to people living with mental illness who require
ongoing intensive treatment, care and support;

b. commission demonstration projects in each region in which a

provider or providers deliver multiple services to people living with
mental illness who require short-term treatment, care or support
and who are in the ‘missing middle’;

c. evaluate demonstration projects to inform decisions on scaling

approaches and expanding to new providers or provider
partnerships that are tailored to the needs of communities and
span the full age spectrum; and

d. monitor provider partnerships using a common set of indicators

with an emphasis on improving mental health and wellbeing
outcomes.

2. in collaboration with Regional Mental Health and Wellbeing Boards

(refer to recommendation 4(2)), work with the Commonwealth and
Primary Health Networks to establish a co-commissioning approach
for Commonwealth and state-funded mental health and wellbeing
services that:
a. builds on joint Commonwealth–state planning approaches to
mental health and wellbeing service delivery; and
b. leverages existing commitments including in the Addendum to
the National Health Reform Agreement 2020–2025.

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Recommendation 52:

Improving the quality and safety of

mental health and wellbeing services

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. by no later than the end of 2021, establish a Mental Health

Improvement Unit within Safer Care Victoria to provide a
multidisciplinary approach to improving the quality and safety of
mental health and wellbeing services.

2. enable the Mental Health Improvement Unit to work with mental

health and wellbeing services to:
a. provide system leadership on quality and safety improvement;
b. provide professional, clinical and practice leadership for mental
health and wellbeing services;
c. promote awareness and understanding of high-quality service
delivery across the mental health and wellbeing system;
d. co-design quality and safety improvement programs with people
with lived experience; and
e. issue practice guidelines and frameworks.

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Recommendation 53:

Strong oversight of the quality and safety

of mental health and wellbeing services

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. enable the Mental Health and Wellbeing Commission (refer to

recommendation 44) to use its full suite of complaints and oversight
functions (refer to recommendation 44(3)) to monitor, inquire into
and report on system-wide quality and safety.

2. facilitate the Mental Health and Wellbeing Commission to monitor, as

matters of priority, the:
a. use of seclusion and restraint;
b. use of compulsory treatment;
c. incidence of gender-based violence in mental health facilities;
and
d. incidence of suicides in healthcare settings.

3. enable the Mental Health and Wellbeing Commission to:

a. work with the Department of Health and relevant regulators to
build a comprehensive understanding of quality and safety issues
in mental health and wellbeing services;
b. ensure on an ongoing basis that complaints-handling and
investigation approaches:
• meet the needs of consumers, families, carers and supporters;
and
• support services to resolve concerns;
c. advise government on issues of concern and areas for
improvement; and
d. record, report and publish service-level complaints and other
relevant data and information.

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Recommendation 54:

Towards the elimination of seclusion and restraint

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. act immediately to reduce the use of seclusion and restraint in

mental health and wellbeing service delivery, with the aim to
eliminate these practices within 10 years.

2. regulate the use of chemical restraint through legislative

provisions in the new Mental Health and Wellbeing Act (refer to
recommendation 42(2)(e)).

3. ensure the Chief Officer for Mental Health and Wellbeing (refer to
recommendation 45(1)) develops and leads a strategy to reduce the
use of seclusion and restraint.

4. enable the Mental Health Improvement Unit within Safer Care Victoria
(refer to recommendation 52(1)) to co-design with mental health
and wellbeing services and people with lived experience a range of
programs and supports aligned with the strategy that focus on:
a. working with each mental health and wellbeing service to
investigate local data and practices in order to identify priority
areas for change;
b. making workforce training available for services; and
c. continuing to support services to embed Safewards.

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Recommendation 55:

Ensuring compulsory treatment is only used as a last resort

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. act immediately to ensure that the use of compulsory treatment is

only used as a last resort.

2. set targets to reduce the use and duration of compulsory treatment

on a year-by-year basis and gather and publish service-level and
system-wide data in this regard.

3. when commissioning mental health and wellbeing services, set

expectations they will provide non-coercive options for people living
with mental illness or psychological distress, including those at risk
of compulsory treatment, in both Local Mental Health and Wellbeing
Services and Area Mental Health and Wellbeing Services.

4. ensure the Mental Health Improvement Unit within Safer Care

Victoria (refer to recommendation 52(1)) works with mental health
and wellbeing services to:
a. increase consumer leadership and participation in all activities to
reduce compulsory treatment;
b. support the design and implementation of local programs,
informed by data, to reduce compulsory treatment; and
c. make available workforce training on non-coercive options for
treatment that is underpinned by human rights and supported
decision-making principles.

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Recommendation 56:

Supporting consumers to exercise their rights

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. promote, protect and ensure the right of people living with mental
illness or psychological distress to the enjoyment of the highest
attainable standard of mental health and wellbeing without
discrimination.

2. include a legislative provision in the new Mental Health and

Wellbeing Act (refer to recommendation 42) enabling an opt-out
model of access to non-legal advocacy services for consumers who
are subject to or at risk of compulsory treatment.

3. increase access to legal representation for consumers who appear

before the Mental Health Tribunal, particularly when consecutive
compulsory treatment orders in the community are being sought.

4. align mental health laws over time with other decision-making laws
with a view to promoting supported decision-making principles and
practices.

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Recommendation 57:

Workforce strategy, planning and structural reform

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. ensure that the range of expanded mental health and wellbeing

services is delivered by a diverse, multidisciplinary mental health
and wellbeing workforce of the necessary size and composition
across Victoria.

2. by the end of 2023, implement and support structural workforce

reforms to:
a. attract, train and transition staff to deliver the core functions
of services across Local, Area and Statewide Mental Health and
Wellbeing Services (refer to recommendation 5); and
b. develop new and enhanced workforce roles as described by the
Royal Commission in its final report.

3. develop, implement and maintain a Workforce Strategy and

Implementation Plan and, by the end of 2021, enable the Department
of Health to:
a. conduct ongoing workforce data collection, analysis and
planning;
b. establish a dedicated workforce planning and strategy function;
and
c. encourage collaborative engagement and partnerships
with relevant workforce stakeholders in implementing
recommendations.

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Recommendation 58:

Workforce capabilities and professional development

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. through the Department of Health, by the end of 2021, define

the knowledge, skills and attributes required of a diverse,
multidisciplinary mental health and wellbeing workforce, starting
with the priorities as described by the Royal Commission.

2. develop a Victorian Mental Health and Wellbeing Workforce

Capability Framework as a component of this.

3. detail the approach to capability development across the mental

health and wellbeing workforce as part of the Workforce Strategy
and Implementation Plan.

4. build on the interim report’s recommendation 1 and enable

the Collaborative Centre for Mental Health and Wellbeing, in
collaboration with training providers, mental health and wellbeing
services and people with lived experience, to coordinate learning
and professional development activities across the whole mental
health and wellbeing workforce.

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Recommendation 59:

Workforce safety and wellbeing

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. by the end of 2021, establish an ongoing Mental Health Workforce

Wellbeing Committee to address occupational health and safety
needs, co-chaired by the Department of Health and WorkSafe
Victoria, that will:
a. identify, monitor and address existing physical safety and
wellbeing risks as well as those that may emerge throughout the
reform process; and
b. develop tailored monitoring approaches for the psychological
health and safety of staff in the mental health and wellbeing
workforce.

2. work with service providers, workers (including lived experience

workers), unions, and representative and professional bodies to set
clear expectations and implement a range of measures to support
the professional wellbeing of the mental health and wellbeing
workforce, as described by the Royal Commission in its final report.

3. beginning in 2021, work with the Mental Health Workforce Wellbeing

Committee to monitor workforce wellbeing outcomes at least once a
year.

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Recommendation 60:

Building a contemporary system through digital technology

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. develop new statewide digital service requirements for all publicly

funded mental health and wellbeing service providers that outline
the consistent minimum digital functionality every provider should
offer to consumers, families, carers and supporters.

2. support mental health and wellbeing service providers to adopt

digital technologies, where safe and appropriate to do so, through:
a. developing regulatory arrangements;
b. providing funding; and
c. building the ability of mental health and wellbeing service
providers to integrate digital technologies.

3. enable mental health and wellbeing services to offer people living

with mental illness or psychological distress access to devices, data
and digital literacy support, where it is their preference to use digital
services but they are otherwise unable to do so.

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Recommendation 61:

Sharing mental health and wellbeing information

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. develop policies, standards and protocols to enable the effective,

safe and efficient collection and sharing of mental health and
wellbeing information.

2. set expectations that mental health and wellbeing services will

provide opportunities for consumers to contribute to the information
held about them and gain easy access to it.

3. collaborate with consumers to introduce a consent-driven approach

to information sharing with mental health and wellbeing services
and individuals outside of the mental health and wellbeing system.

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Recommendation 62:

Contemporary information architecture

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. develop, fund and implement modern infrastructure for Information

and Communications Technology (ICT) systems, including:
a. a new statewide Electronic Mental Health and Wellbeing Record
for mental health and wellbeing services to replace the current
Client Management Interface/Operational Data Store (CMI/ODS)
system;

b. a review of data items currently required for service delivery

and system administration, the removal of unused items and
the addition of new items that accurately reflect mental health
service activity and consumer outcomes;

c. a new Mental Health Information and Data Exchange that

allows interoperability between the proposed Mental Health
and Wellbeing Record and other services’ major ICT systems
to support information sharing in real-time within and across
services and sectors;

d. a new user-friendly online consumer portal (web and mobile)

connected to the Mental Health Information and Data Exchange
that allows consumers to view key information about themselves
and authorise sharing of information with members of their care
team, including families, carers and supporters; and

e. a comprehensive data repository and associated clinical

registries for mental health (within the recommended Mental
Health Information and Data Exchange) that will support outcome
measurement, future service planning, continuous improvement
and mental health research.

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Recommendation 63:

Facilitating translational research and its dissemination

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. building on the interim report’s recommendation 1, by the end

of 2023, enable the Collaborative Centre for Mental Health and
Wellbeing to:
a. facilitate translational research throughout the mental health and
wellbeing system, including in collaboration with other research
centres and institutes;
b. ensure new research aligns with initial reform priorities identified
by the Royal Commission;
c. strengthen and support a formal network of academic service
leaders responsible for sharing and applying research in service
settings;
d. ensure that evidence informs workforce education and training,
and promotes cultures of inquiry, innovation and learning;
e. provide a ‘clearing house’ to collect, combine and share
information from research, innovation projects and evaluations;
and
f. provide authoritative advice on evidence-informed approaches
to treatment, care and support to inform policy development,
planning and investment.

2. identify and promote opportunities to increase collaboration in

translational research on the mental health and wellbeing of infants,
children and young people.

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Recommendation 64:

Driving innovation in mental health

treatment, care and support

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. commission an existing entity to provide dedicated support and

resources for innovation in mental health treatment, care and
support.

2. fund this entity to:

a. administer a dedicated mental health innovation fund for projects
selected by an expert panel;
b. establish and promote collaborative networks to drive and
facilitate innovation in mental health treatment, care and
support; and
c. provide practical support to services to implement and test new
approaches to mental health treatment, care and support.

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Recommendation 65:

Evaluating mental health and wellbeing

programs, initiatives and innovations

Recommendation component Time horizon

Short Medium Long

(by end (by end (by end
of 2022) of 2026) of 2031)

1. set an expectation that adequate evaluation is a condition of

funding for all new mental health and wellbeing programs, initiatives
and innovations.

2. develop and fund a strategy to ensure evaluation routinely informs

the implementation of reforms and ongoing decision making about
policies and investment.

3. promote and improve evaluation practices throughout the mental

health and wellbeing system by issuing guidance and facilitating
access to evaluation expertise.

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1 Royal Commission into Victoria’s Mental Health System, Interim Report, 2019, p. 385.
2 Victorian Government, Royal Commission into Victoria’s Mental Health System—Letters Patent, 2019, para. I.
3 Dr Dahle Suggett, Occasional Paper No. 15: The Implementation Challenge: Strategy Is Only as Good as Its
Execution, 2011, p. 3.
4 Implementation is about putting decisions into practice, refer to: Bianca Albers, Mary Abdo and Robyn Mildon,
Implementing the Commission’s Recommendations: Prepared by the Centre for Evidence and Implementation
for the Royal Commission into Victoria’s Mental Health System, 2020, p. 2. The Commission arranged this report
from the Centre for Evidence and Implementation to inform development of this chapter. The Commission
acknowledges Bianca Albers, Mary Abdo and Robyn Mildon for this work.
5 Royal Commission into Victoria’s Mental Health System, Interim Report, pp. 568–570.
6 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 1.
7 John Mendoza, Kathleen Margaret Griffiths and Sebastian Pascal Rosenberg, Obsessive Hope Disorder: Reflections
on 30 Years of Mental Health Reform and Visions for the Future: Summary Report, 2013, p. 11.
8 The Victorian Mental Illness Awareness Council, Correspondence to the RCVMHS: Governance in Mental Health,
2020, p. 13.
9 See for example, Family Violence Reform Implementation Monitor, Report of the Family Violence Reform
Implementation Monitor as at 1 November 2018, 2018, p. iv.
10 Parenting Research Centre, Implementation of Recommendations Arising from Previous Inquiries of Relevance to
the Royal Commission into Institutional Responses to Child Sexual Abuse Final Report, 2015, pp. xiv and 22.
11 Albers, Abdo and Mildon, p. 1; Parenting Research Centre, pp. xv–xvi.
12 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 121.
13 Joint Witness Statement of ‘Mary Corbett’ and ‘Jacob Corbett’ (pseudonyms), 25 June 2020, para. 119.
14 Mendoza, Griffiths and Rosenberg, p. 43.
15 Victorian Government, Announcement: Royal Commission into Mental Health Speech, 24 October 2018, p. 4.
16 Michael Mintrom, Deirdre O’Neill and Ruby O’Connor, ‘Royal Commissions and Policy Influence’, Australian Journal
of Public Administration, 2020, 1–17 (pp. 4 and 15).
17 Victorian Government, Royal Commission into Victoria’s Mental Health System—Letters Patent, para. III.
18 Throughout this chapter, the Commission defines ‘implementation partners’ or ‘implementers’ as all those involved
in implementing the Commission’s reform agenda. This includes the Victorian Government, the workforce, service
providers, people with lived experience of mental illness or psychological distress, families, carers, supporters and
the Victorian community more broadly. It also extends to involvement from the Commonwealth Government and
other human services systems.
19 Parenting Research Centre, p. 90.
20 Witness Statement of Dr Chris Groot, 4 September 2019, para. 16; Professor Patrick McGorry, Mental Illness Is More
Ubiquitous Than Cancer. How Can We Help the “Missing Middle”?, The Guardian, 25 April 2019, p. 2.
21 Beyond Blue, Beyond Blue Chair The Hon. Julia Gillard AC Delivers the 2019 Diego De Leo Address, 23 July 2019,
<www.beyondblue.org.au/media/news/news/2019/07/22/beyond-blue-chair-the-hon-julia-gillard-ac-delivers-the-
2019-diego-de-leo-address>, [accessed 3 December 2020].
22 Witness Statement of Professor Bruce Bonyhady AM, 16 June 2020, para. 33.
23 Royal Commission into National Natural Disaster Arrangements, Transcript of Proceedings, Day 29, 5 August
2020, p. 2595.
24 Parenting Research Centre, p. 93.
25 Witness Statement of Georgie Harman, 1 July 2019, para. 106.
26 Witness Statement of Associate Professor Ruth Vine, 27 June 2019, para. 97.
27 Beyond Blue, Media Release: Beyond Blue Backs National Mental Health and Wellbeing Pandemic Response Plan, 15
May 2020, p. 1.
28 Witness Statement of Professor Rob Moodie, 9 June 2020, para. 15.
29 Patrick D McGorry and Matthew P Hamilton, ‘Broken Promises and Missing Steps in Mental Health Reform’, Medical
Journal of Australia, 206.11 (2017), 487–489 (p. 488).
30 Witness Statement of Kym Peake, 24 July 2019, para. 188; Parenting Research Centre, p. 94.
31 Anne-marie Boxall, Chapter 11: Medicare: The Making and Consolidation of an Australian Institution, in Successful
Public Policy: Lessons from Australia and New Zealand (Canberra: ANU Press, 2019), pp. 257–278 (p. 260); Witness
Statement of Kym Peake, 2019, paras. 188–190.
32 Witness Statement of Professor David Copolov AO, 7 July 2020, para. 296(b).
33 Parenting Research Centre, p. 154.
34 Witness Statement of Kym Peake, 4 October 2020, para. 132.

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35 Parenting Research Centre, p. 138.

36 Witness Statement of Professor Patrick McGorry AO, 22 June 2020, para. 143.
37 Royal Commission into Victoria’s Mental Health System, Interim Report, pp. 535–536.
38 Parenting Research Centre, pp. 138–139.
39 Madeline M Carter, The Importance of Collaborative Leadership in Achieving Effective Criminal Justice Outcomes
(Center for Effective Public Policy, Department of Justice National Institute of Corrections, 2006), p. 3.
40 Grace Ann Rosile, David M Boje and Carma M Claw, ‘Ensemble Leadership Theory: Collectivist, Relational, and
Heterarchical Roots from Indigenous Contexts’, Leadership, 14.3 (2018), 307–328 (pp. 309–311).
41 Witness Statement of Kym Peake, 2020, para. 138.
42 Parenting Research Centre, p. 158.
43 Carter, p. 3.
44 Witness Statement of Professor Patrick McGorry AO, para. 144.
45 Witness Statement of Associate Professor Simon Stafrace, 14 August 2020, para. 13.
46 Royal Commission into Victoria’s Mental Health System, Interim Report, pp. 535–536.
47 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 537; Witness Statement of Associate
Professor Simon Stafrace, 2020, paras. 60–61.
48 Witness Statement of Janet Meagher AM, 1 July 2019, para. 36.
49 Witness Statement of ‘Rachel Bateman’ (pseudonym), 16 June 2020, para. 56.
50 Cath Roper, Flick Grey and Emma Cadogan, Co-Production: Putting Principles into Practice in Mental Health
Contexts, 2018, p. 2.
51 Roper, Grey and Cadogan, p. 4.
52 Witness Statement of Cath Roper, 2 June 2020, paras. 8–9; Roper, Grey, and Cadogan, pp. 5–6.
53 Witness Statement of Graham Panther, 6 July 2020, para. 137.
54 Julie Slay and Lucie Stephens, Co-Production in Mental Health: A Literature Review, 2013, p. 16; Mike Spencer, Ruth
Dineen and Andrew Phillips, Co-Producing Service—Co-Creating Health: Tools for Improvement, 2013, p. 10.
55 Witness Statement of Cath Roper, para. 17; Witness Statement of ‘Rachel Bateman’ (pseudonym), para. 59.
56 Witness Statement of Erandathie Jayakody, 4 June 2020, para. 69.
57 Witness Statement of Dr Melissa Petrakis, 11 May 2020, para. 50(b).
58 Roper, Grey and Cadogan, p. 5.
59 RCVMHS, Consumer Foundations Working Group Meeting Summary, October 2020, p. 19.
60 Witness Statement of Indigo Daya, 12 May 2020, para. 86.
61 Albers, Abdo and Mildon, p. 16.
62 Witness Statement of Cath Roper, para. 33.
63 Albers, Abdo and Mildon, pp. 16–17.
64 Roper, Grey and Cadogan, p. 5.
65 Indigo Daya, Bridget Hamilton and Cath Roper, Authentic Engagement: A Conceptual Model for Welcoming Diverse
and Challenging Consumer and Survivor Views in Mental Health Research, Policy, and Practice, International
Journal of Mental Health Nursing, 29.2 (2020), 299–311 (pp. 300 and 309).
66 Roper, Grey and Cadogan, pp. 6 and 10; Witness Statement of Erandathie Jayakody, para. 72(c).
67 Anonymous, Brief Comments to the RCVMHS: SUB.0001.0003.0021, 2019, p. 5.
68 Evidence of Al Gabb, 15 July 2019, p. 950.
69 Anne-Marie Skegg, Submission to the RCVMHS: SUB.0002.0028.0623, 2019, p. 2.
70 Witness Statement of Kym Peake, 2020, para. 139.
71 Witness Statement of David Pearl, 11 May 2020, para. 21.
72 Anonymous 419, Submission to the RCVMHS: SUB.0002.0013.0002, 2019, p. 5.
73 National Mental Health Commission, Consumer and Carer Engagement: A Practical Guide, 2019, p. 4.
74 Consumer Foundations Working Group, Correspondence to the RCVMHS: Consumer Leadership and Mobilisation,
2020, p. 8.
75 ORIMA Research, Mental Health Workforce Survey, 2020, p. 37.
76 ORIMA Research, p. 40.
77 Commission Analysis of ORIMA Research, Mental Health Workforce Survey, 2020.
78 Commission Analysis of ORIMA Research, Mental Health Workforce Survey, 2020.
79 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 45.

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80 Australian Evaluation Society, Talking About Evaluation, <aes.asn.au/talking-about-evaluation>, [accessed 12

October 2020].
81 Catherine Althaus, Peter Bridgman and Glyn Davis, Chapter 11: Evaluation, in The Australian Policy Handbook: A
Practical Guide to the Policy-Making Process, Sixth Edition (Allen and Unwin Academic, 2017), pp. 200–214 (p. 209).
82 Department of Treasury and Finance, Performance Management Framework: For Victorian Government
Departments March 2016, 2017, p. 32.
83 Evert A. Lindquist and John Wanna, Chapter 1: Delivering Policy Reform: Making It Happen, Making It Stick, in
Delivering Policy Reform: Anchoring Significant Reforms in Turbulent Times (Canberra: ANU E Press, 2011), pp.
1–12 (p. 8).
84 Parenting Research Centre, pp. 99 and 137.
85 Joannah Luetjens, Michael Mintrom and Paul ’t Hart, Successful Public Policy: Lessons from Australia and New
Zealand (Canberra: ANU Press, 2019), p. 19.
86 Nina Hemmings and others, Achieving Scale and Spread: Summary of Learning for Innovators and Policy-Makers,
2020, p. 6.
87 Albers, Abdo and Mildon, p. 10.
88 Hemmings and others, p. 9.
89 Productivity Commission, Mental Health Inquiry Report, Volume 3, 2020, pp. 1118–1119.
90 Productivity Commission, Mental Health Inquiry Report, Volume 3, p. 1234.
91 Productivity Commission, Mental Health Inquiry Report, Volume 3, p. 1123.
92 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 116.
93 The Honourable Josh Frydenberg MP, Treasurer of the Commonwealth of Australia, National Accounts June
Quarter Statement Speech, 2 September 2020, <ministers.treasury.gov.au/ministers/josh-frydenberg-2018/
speeches/national-accounts-june-quarter-statement>, [accessed 21 December 2020].
94 ABC News, Australia “Emerges from Recession” After GDP Figures Show Economy Growing for the First Time This
Year, 2 December 2020, <www.abc.net.au/news/2020-12-02/australia-september-quarter-economic-growth-gdp-
figures/12934336>, [accessed 3 November 2020].
95 Royal Commission into Victoria’s Mental Health System, Interim Report, pp. 361–362.
96 Productivity Commission, Mental Health Inquiry Report, Volume 2, 2020, p. 153.
97 Royal Commission into Victoria’s Mental Health System, Interim Report, pp. 543–544.
98 The Honourable Daniel Andrews MP, Premier of Victoria, Media Release: Putting The Mental Health of Victorians
First, 12 November 2020, <www.premier.vic.gov.au/putting-mental-health-victorians-first>, [accessed 12 November
2020]; Victorian Government, Victorian Budget 2020–21: Treasurer’s Speech: Budget Paper No. 1, 2020, p. 11.
99 Victorian Government, Victorian Budget 2020–21: Treasurer’s Speech: Budget Paper No. 1, p. 11.
100 Royal Commission into Victoria’s Mental Health System, Interim Report, pp. 374–378
101 Productivity Commission, Mental Health Inquiry Report, Volume 2, p. 172.
102 Elaine Henry, ‘Chapter 11: Perspectives of Community Organisations: The Smith Family Experience’, in Collaborative
Governance: A New Era of Public Policy in Australia? (Canberra: ANU E Press, 2008), pp. 113–120 (p. 117).
103 Janine O’Flynn, Chapter 17: Elusive Appeal or Aspirational Ideal? The Rhetoric and Reality of the “Collaborative
Turn” in Public Policy, in Collaborative Governance: A New Era of Public Policy in Australia? (Canberra: ANU E Press,
2008), pp. 181–195 (p. 185).
104 Witness Statement of Dr Hila Haskelberg, 13 July 2020, para. 35(a).
105 Witness Statement of Dr Hila Haskelberg, para. 35.
106 Witness Statement of Dr Tricia Szirom, 12 May 2020, para. 36.
107 Beth Noveck and Rod Glover, Today’s Problems, Yesterday’s Toolkit (Australia and New Zealand School of
Government (ANZSOG), 2019), p. 15
108 RCVMHS, Public Health Roundtable: Record of Proceedings, 2020.
109 Witness Statement of Associate Professor Ruth Vine, 2019, para. 111.2; Jennifer Doggett, The Personal and the
Political, Inside Story, 15 June 2019.
110 Royal Commission into Victoria’s Mental Health System, Interim Report, pp. 172–177; Victorian Auditor-General’s
Office, Access to Mental Health Services, 2019, p. 25.
111 Family Violence Reform Implementation Monitor, Report of the Family Violence Reform Implementation Monitor as
at 1 November 2019, 2020, p. 46.
112 Bushfires Royal Commission Implementation Monitor: Final Report, 2012, p. 224.
113 Commission analysis of the Department of Health (Commonwealth), National Mental Health Service Planning
Framework, 2018; Department of Environment, Land, Water and Planning, Victoria in Future 2019, 2019; Australian

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Institute of Health and Welfare, Mental Health Services in Australia: Specialised Mental Health Care Facilities
2017–18 Tables Table FAC.3.
114 Albers, Abdo and Mildon, p. 20.
115 Roper, Grey and Cadogan, p. 7.
116 Dr Peter Shergold, Chapter 2: Governing Through Collaboration, in Collaborative Governance: A New Era of Public
Policy in Australia? (Canberra: ANU E Press, 2008), pp. 13–22 (p. 20).
117 Albers, Abdo and Mildon, pp. 13–15; Witness Statement of Kym Peake, 2020, paras. 141–142 and 145(d).
118 Parenting Research Centre, p. 91; Witness Statement of Kym Peake, 2020, para. 132.
119 RCVMHS, Consumer Foundations Working Group Meeting Summary, p. 18.
120 Albers, Abdo and Mildon, p. 20.
121 Family Violence Reform Implementation Monitor, Report of the Family Violence Reform Implementation Monitor as
at 1 November 2017, 2017, p. 12.
122 Commonwealth Government, Our Public Service, Our Future. Independent Review of the Australian Public Service,
2019, p. 278.
123 Crick Lund and others, Social Determinants of Mental Disorders and the Sustainable Development Goals: A
Systematic Review of Reviews, The Lancet Psychiatry, 5 (2018), 357–369 (p. 357).
124 Commonwealth Government, p. 278.
125 The Honourable Daniel Andrews MP, Premier of Victoria, Media Release: New Departments To Deliver A Healthier,
Fairer Victoria, 30 November 2020, <www.premier.vic.gov.au/new-departments-deliver-healthier-fairer-victoria>,
[accessed 1 December 2020].
126 The Victorian Mental Illness Awareness Council, p. 13.
127 Witness Statement of Lin Hatfield Dodds, 15 June 2020, para. 47.
128 Albers, Abdo and Mildon, pp. 20–21.
129 Family Violence Reform Implementation Monitor, Report of the Family Violence Reform Implementation Monitor as
at 1 November 2018, pp. 11–12.
130 Family Violence Reform Implementation Monitor, Report of the Family Violence Reform Implementation Monitor as
at 1 November 2018, p. 14.
131 Parenting Research Centre, pp. 142–143.
132 Parenting Research Centre, p. 144.
133 Parenting Research Centre, p. xvii.
134 Victorian Bushfires Royal Commission, Volume 2, Chapter 12: Monitoring Implementation, 2010, p. 404.
135 Royal Commission into Family Violence, Report and Recommendations, Volume VI, 2016, p. 133.
136 Parenting Research Centre, p. 146.
137 Parenting Research Centre, p. 87.
138 Parenting Research Centre, p. 147.
139 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 67(d).
140 Witness Statement of Associate Professor Ruth Vine, 2019, para. 125.
141 Parenting Research Centre, p. 157.
142 Witness Statement of Associate Professor Simon Stafrace, 2020, para. 67(d).
143 Albers, Abdo and Mildon, p. 18.
144 Parenting Research Centre, p. 157.
145 Albers, Abdo and Mildon, p. 19.
146 Royal Commission into Institutional Responses to Child Sexual Abuse, Final Report: Making Institutions Child Safe,
Volume 6, 2017, p. 19.
147 Victorian Government, Royal Commission into Victoria’s Mental Health System—Letters Patent, para. III.
148 Family Violence Reform Implementation Monitor, Report of the Family Violence Reform Implementation Monitor as
at 1 November 2017, p. 4.
149 Family Violence Reform Implementation Monitor, Report of the Family Violence Reform Implementation Monitor as
at 1 November 2017, p. 4.
150 Albers, Abdo and Mildon, p. 18.

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A note from the CEO

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A message from the CEO

Working on a royal commission is an extraordinary privilege. From the first days of this
Commission, in which the Chair and I met with commissioners and CEOs of previous royal
commissions, through to preparing the final report for printing and delivery to the Governor,
it has been clear that this opportunity was different to many others.

As royal commissions before us showed, the most rewarding part of conducting a commission
is engaging with people and learning from the experiences they share. Thousands of
people—people with lived experience of mental illness or psychological distress, families,
carers and supporters, and people who work in and manage the system—gave their time and
wisdom to the Commission. From all over Victoria, and indeed other parts of Australia and
overseas, people came forward, voluntarily, to contribute, and the Commission encouraged
them to do so in many different ways. The experience of listening to people’s thoughts and
aspirations, and the collective desire to create a better future, gave meaning and purpose to
the Commission. This sense of shared hope is reflected in this report.

There were many special moments during the course of our work, in the sharing of stories,
that went to the heart of human experience. Indeed, a royal commission is really a series of
these special moments. Some of them were shared publicly, in community consultations, in
which many people, sitting in deep grief, were comforted by strangers. Some contributions
were more private, sent anonymously to the Commission. For many, it took a lot of courage to
take part. Commission staff will long remember the strength of the people who stood to take
the microphone, or even a seat at a table, at the community consultations. There were many
occasions at our public hearings too, where formality gave way to emotion—not just for the
witnesses sharing their experience, but also for Commission staff and Commissioners. Finally,
people said they felt ‘heard’, and for some this was the first time they felt their ideas and
aspirations were valued. Many carers and family witnesses told us a heavy weight they had
carried was lifted by the public acknowledgment that it was not them who had failed their
loved one, but the system.

Moments like these highlighted the importance of a royal commission as a vehicle for
engagement and change. There is no doubt that the lives of all Commission staff have been
enriched by the experiences shared, and by the community’s generosity towards our work.

Establishing a royal commission

From the outset, how the Commission was constituted was deemed just as important as its
policy and legal work. Selecting staff with the right skillsets and characteristics was a priority.
We were guided by previous royal commissions, and paid attention not only to the formal
requirements of a royal commission, but also to what was needed to respect and harness the
goodwill demonstrated by the community.

The Chair and I focused on the qualities we required for a diverse, yet united team. We were
influenced in particular by the knowledge of the executives of the Royal Commission into
Institutional Responses to Child Sexual Abuse, whom we consulted in our formative stages.

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They advised that we would require staff with endurance and, in equal measure, the nature
to treat people engaging with the Commission with kindness and respect. They spoke of the
importance of gestures that made witnesses feel valued—opening their car door when they
arrived at a hearing, making a follow-up call afterward—as being critical to the process, and
to how those involved would remember their experience. This wisdom guided us in building
our team, and we selected every staff member with these characteristics in mind.

We were also encouraged to ensure that the diversity of skills and teams present did
not result in division. A royal commission is a pressured environment, united by purpose
but presented with many pathways to reach the end point, all of them unrelenting and
exhausting. It was necessary to ensure all teams, legal and policy, and the community
engagement team, worked together and recognised the separate but critical contributions
each made.

I am proud to say that despite the difficulty and operational demands of forming a royal
commission, we did have the team we wanted: people committed to the purpose of the
Commission, with respect for its process, each other and the community. The Commission
worked harmoniously, and it was a privilege to work alongside all staff, the Counsel Assisting
appointed by the Chair, our contractors, the Expert Advisory Committee and Consumer
Foundations Working Group, and our legal firm, Herbert Smith Freehills.

The operations of the Commission

The Commission operated during 2019 and 2020, years that will long be marked in
Victoria’s history for two devastating events: the 2019–20 summer bushfires and the
COVID-19 pandemic.

The impacts of these events, and the related uncertainties, tragedies and losses, influenced
our work. These forces shaped the mental health system, and the wellbeing of communities,
as the Commission deliberated. As explained throughout this report, the focus of our work
became how to best support people through crisis and tragedy and bolster the system’s
long-term adaptability.

The pandemic also changed the way we worked, with staff spending most of 2020 working
remotely. This presented challenges. Some, like the cancellation of our final round of public
hearings, were visible, while others were less so, such as the personal isolation staff felt and
the challenge of connecting ideas at a distance. Yet, undeterred and motivated to ensure the
Commission delivered on its commitment to transform the Victorian mental health system,
staff adapted to the new arrangements and worked tirelessly to ensure the Commission’s
work was done.

Leading the staff through the Commission’s enormous work program, including the
unexpected challenges 2020 brought, was a remarkably talented and thoughtful executive
leadership group. Listed in the order they started at the Commission, and noting some stayed
for the duration while others gave the time they could, they are: Maria Perera, Luke Horwill,
Phil Ames, Fayyaz Khan, Nicola Farray, Rhys Benny, Kerin Leonard, Phuong Nguyen, Luke
Bo’sher, Tessa Piper, Charlotte Frew, James Lavery, Erica Grundell and Caroline Aebersold. I
also acknowledge the contribution of Dan Jefferson, who stood in briefly as Interim CEO while

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I was seconded to the Department of Health and Human Services to assist with the response
to the COVID-19 pandemic.

I also acknowledge the persistence and talents of my Strategic Adviser, Shane Robertson,
and the deliberate and reflective work of both Cath Roper, Lived Experience Adviser, and the
Commission’s Aboriginal Adviser, Nicole Cassar.

The Department of Health and Human Services and the Department of Premier and Cabinet
were critical in the Commission’s establishment phase, deploying key staff to assist in its
early weeks. In particular I want to thank Greg Wilson, Emma Fenby and Alison Rutherford.
I am also grateful for the early support of Ben Rimmer, who joined briefly as a strategic
adviser, and the ongoing support of Ross Broad, Director, Royal Commission Engagement
Branch, Department of Health and Human Services. Mr Broad coordinated responses to
the Commission’s Notices to Produce and numerous requests it made for information from
multiple government departments.

The operational aspects of the Commission and the work of its leadership team and
other staff are presented in the following chapters. These provide a formal record in the
hope it supports future royal commissions as we have been supported by those before
us. The chapters also explain the expectation we set to work to the highest standards
of transparency and integrity and as prescribed by the Inquiries Act 2014 (Vic). The
Commission’s policies and protocols now form part of the public record.

Innovation in royal commissions

Each royal commission is established in unique circumstances, and each pushes new
frontiers. These efforts often pave the way for those that come after them. Because the
2009 Victorian Bushfires Royal Commission reached into communities, holding gatherings in
town halls, for example, this Commission did not feel that its inquiry should be confined to a
hearings room.

The 2015 Royal Commission into Family Violence showed how royal commissions could
focus on policy with an eye to the future, rather than only on past events. This example, too,
encouraged us to think differently, and this is evident in the ‘systems design’ approach that
informed our work.

This Commission chose to harness the licence its letters patent gave it to go beyond system
improvement and to look forward to the future—and deliver a complete redesign of Victoria’s
mental health system. In many respects, the Commission was a leader of systems change
practice. It sought the input of people with experience in diverse areas of business, academia,
systems engineering and design, implementation science, public policy, regulation, digital
services and social innovation. Many of these people had no direct expertise in mental health,
but enriched the Commission’s ability to ‘think in systems’. In particular, they helped the
Commission to see and understand the complexity of Victoria’s mental health system and
identify ways to transform it. The Commission particularly acknowledges those who advised
it through its systems advisory function.

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The Commission has also reflected on the Victorian Government’s commitment to implement
its recommendations. This commitment, along with the Commission’s focus on the future
system, has been instrumental in shaping the work. The focus shifted away from changing
individual services and programs, toward the full system—its structures, practices, services,
policies, resources, power dynamics, relationships and connections, values and beliefs—that,
collectively reformed, will deliver better outcomes for Victorians.

We hope that in some small way, we opened up new possibilities for royal
commissions to come.

Final words
All royal commissions will unfold differently, yet every CEO who establishes one will be
challenged by the rapid momentum they generate, the expectations they set, and the
pressing need for integrity of process in the face of tight timelines and significant legal and
policy questions.

The work of the Commission, as described in this report, speaks to the dedication of the staff
and the rigorous processes followed. It is an important record for Victoria.

The Commission’s task—to redesign a mental health system—was enormous. Despite

searching, we could not find an example of where an inquiry had been given a comparable
challenge.

To undertake this momentous work with the Commission staff, to work alongside the Chair of
the Commission and with the other Commissioners, and with Counsel Assisting and the legal
team—and to meet so many of the people who shared their stories—has been an honour.

Jodie Geissler
Chief Executive Officer,
Royal Commission into
Victoria’s Mental Health System

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Chapter 38

The establishment
of the Commission

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38.1  Inquiry announced

On 24 October 2018, the Victorian Premier, the Hon. Daniel Andrews MP, announced that,
if re‑elected, the government would commit to a royal commission into mental health.1
Reflecting on the personal mental health experiences of Victorians that he had heard, the
Premier said the ‘royal commission would be for everyone in this state—and ultimately, this
country—who has ever felt like they had nowhere to turn, no one to rely on and nothing to
hope for’,2 and that it would ‘bring mental health out of the darkness into the blinding light’.3

On 22 February 2019, Her Excellency, the Hon. Linda Dessau AC, the Governor of the State of
Victoria, formally established the Royal Commission into Victoria’s Mental Health System.

The same day, the Premier said the mental health system is ‘a broken system and until we
acknowledge that and set a course to find those answers and a practical plan for the future,
people will continue to die, people will continue to be forever diminished’..4

The Premier had previously committed to implementing all of the Commission’s

recommendations.5 The letters patent required the Commission to report on ‘how Victoria’s
mental health system can most effectively prevent mental illness, and deliver treatment, care
and support, so that all those in the Victorian community can experience their best mental
health, now and into the future’.6 The letters patent were critical in guiding the work of the
Commission over the life of the inquiry.

The work of the Commission was also bound by the Inquiries Act 2014 (Vic) which outlines
the conduct of royal commissions.7 The Commission conducted the inquiry in line with the
requirements of procedural fairness, letters patent and the Inquiries Act.8 The Commission
was supported by the Department of Premier and Cabinet, which assisted with the
establishment phase, and some operational and corporate functions.

Appendix A.1 shows the Commission’s letters patent.

38.2  Interim report delivered

The Commission delivered an interim report on 27 November 2019. The report outlined the
challenges facing Victoria’s mental health system, and made nine recommendations in
response to some of the most immediate challenges faced by Victorians with poor mental
health, by families, carers and supporters, and those working in the sector.9

38.3  Inquiry extended

The letters patent required the Commission to deliver a final report by 31 October 2020.10
However, as a result of the impact of COVID-19—and the need to find alternative ways of
working with health services, government departments and people with lived experience—
the Commission requested a three-month extension.11

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On 26 May 2020, the Governor formally extended the Commission’s final report deadline
to 5 February 2021.12

Appendix A.2 shows the Commission’s amended letters patent granting the extension.

The extension allowed the Commission to explore mental health and wellbeing issues that
became increasingly prominent during the COVID-19 pandemic, such as loneliness and social
isolation and the importance of telehealth.

38.4  Impact of COVID-19

In March 2020, Victoria began adopting measures to prevent the transmission of COVID-19.
The Premier recommended that Victorians who were able to work from home should do so
to limit their exposure to the virus. Accordingly, Commission staff began working from home
from 23 March 2020.

The pandemic had an impact on the Commission’s operations. Like many Victorians,
Commissioners and the Commission staff had to adapt quickly. They continued to engage
with the community, meet with interested parties, workshop ideas, collaborate, research
and write—all remotely. One important impact of the pandemic on the Commission was
cancelling the second round of public hearings, which were to take place in April 2020. The
Commission announced the cancellation of the hearings on 19 March 2020, during the early
stage of the COVID-19 pandemic.13 This was in response to government health advice to
protect the health and safety of participants and the general public.

A COVIDSafe Plan was established in the Commission under the direction of a small
committee. This plan outlined the measures to be put in place to minimise the risk of
transmitting COVID-19 in the workplace, and appropriate procedures to ensure the health
and safety of Commissioners and staff while working in the office and remotely.

To support staff wellbeing during their 10 months of remote working, and at a time of such
uncertainty, the Commission put a number of measures in place. These included regular
counselling sessions for staff, and wellbeing workshops to help staff deal with challenges
such as change, social isolation and balancing work with caring responsibilities. This was
complemented with flexible working arrangements, regular discussions among the leadership
team, and updates from the Chair and CEO to staff, including about how to best manage the
impacts of COVID-19.

The Commission also implemented security measures to ensure documents were protected
and processes were maintained during remote working. This included the delivery of
information management and security training, and regular communication to staff about
risk management, confidentiality and document security protocols.

To ensure calls from the public were being attended to, phone lines were redirected to staff
working from home, making sure all calls from the public could be answered, and that
support was provided when required.

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38.5  Commissioners appointed

The Governor appointed four Commissioners to lead the inquiry, based on their expertise
in public policy and the mental health sector.14

Penny Armytage AM (Chair)

Penny Armytage AM has held senior executive positions

in the Victorian public service, including Secretary of the
former Department of Justice.

Penny has overseen major policy and service delivery

reforms in the justice and human services sectors. She has
worked extensively with ministers, department and agency
leaders, and heads of jurisdiction across the Victorian
public sector and nationally.

Penny conducted the Youth Justice Review and Strategy:

Meeting Needs and Reducing Offending review and was
chair of the Independent Inquiry into the Environment
Protection Authority.

She has also been the chair of the Transport Accident Commission board and president
of the board of Berry Street, an independent family services organisation. She was the
National President of the Institute of Public Administration Australia.

Dr Alex Cockram (Commissioner)

Dr Alex Cockram is a psychiatrist, a clinician and a leader

in mental health and acute health care. Alex is an advocate
for workforce training and development that supports
better patient and community outcomes.

Alex has advised government in areas including mental

health, alcohol and other drug service system reform, and
on the interface between the National Disability Insurance
Scheme and the health system.

She has helped improve outcomes for consumers, families

and carers, working with key stakeholders to develop
regional strategies that better integrate mental health
and alcohol and other drug service systems in primary,
community and specialist care settings.

Alex was previously the CEO of Western Health, before she joined the board of Epworth
HealthCare group, one of Australia’s largest not-for-profit healthcare providers. She is
also a board director of the Central Adelaide Local Health Network.

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Professor Allan Fels AO (Commissioner)

Professor Allan Fels AO has held several senior chair

positions throughout his career, including chair of the
Australian Competition and Consumer Commission, chair
of the National Mental Health Commission and chair of
the Haven Foundation, which provides accommodation,
care and support for people with lived experience of
mental illness.

Allan is on the board of Mind Australia and a patron

of Mental Health Victoria. He also has a daughter with
schizophrenia and is a carer.

Allan is an honorary professor at the University of

Melbourne, Monash University and Oxford University.

Professor Bernadette McSherry (Commissioner)

Professor Bernadette McSherry is an internationally

recognised legal academic in criminal law and mental
health law. Bernadette is the Foundation Director of the
Melbourne Social Equity Institute and Professor of Law at
the University of Melbourne.

Throughout her career, Bernadette has held many senior

positions such as the Louis Waller Chair of Law and
Associate Dean (Research) in the Faculty of Law, Monash
University. She was appointed an Australian Research
Council Federation Fellow and established the Centre for
the Advancement of Law and Mental Health as part of this
prestigious fellowship.

The Victorian Government appointed Bernadette to the

Complex Adult Victim Sex Offender Management Review Panel. She has also served as a
member of the Victorian Government’s Criminal Law Justice Statement Advisory Group and
the Expert Advisory Panel, Victorian Government Courts and Programs Development Unit.

Bernadette is the immediate past president of the Australian and New Zealand Association of
Psychiatry, Psychology and Law. For seventeen years, she was a legal member of the Mental
Health Tribunal of Victoria. She is currently a Commissioner of the Victorian Law Reform
Commission.

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38.6  Staff at the Commission

Commission staff came from a variety of backgrounds with a vast array of skills and
experience. They joined the Commission from the Victorian public sector, the health sector,
non-government organisations and the private sector. They brought a depth of skill in
policy and research, working with the community, corporate operations and in legal, data
management and support functions.

Many staff had lived experience of mental illness or psychological distress, including as
consumers and carers. The Commission also employed Ms Cath Roper as a special adviser
on consumer lived experience, and Ms Nicole Cassar as a special adviser on Aboriginal
engagement.

There was a high level of flexibility in work arrangements due to the nature of the
Commission’s work. Some staff members worked for the full length of the Commission and
some joined for short-term engagements; work ranged from part to full-time. This level of
flexibility occurred across all teams.

Led by Jodie Geissler, CEO, and supported by the

Executive Leadership Group, Commission staff were
organised into four branches: the Policy and Research
branch, the Community Engagement branch, the Advisors
and Executive Support branch, and the Corporate
Services branch.

The Commissioners thank all staff for their contribution.

Table 38.1 lists all the staff who contributed to the

Commission’s work.

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Table 38.1:  Commission staff

Name Name Name

Dr Caroline Aebersold Stephen Gow Lisa Orth

Phil Ames Miriam Greig Mandy Pateras

John Argyropoulos Robert Gruhn Maria Perera

David Arkell Erica Grundell Julie Petering

Rhys Benny Christian Habla Deirdre Pinto

Madelaine Blomfield Heather Harding Tessa Piper

Jane Blurton Matthew Haworth Estelle Polevoy

Troy Bogaart Sarah Jane Haywood Dr Sarah Pollock

Luke Bo’sher Claire Hopkins Shane Robertson

Daizee Boucher Luke Horwill Louise Robinson

Teresa Calabria Karen Hutchinson Joanna Rolfe

Nicole Cassar Renee Imbesi Cath Roper

Gavin Chandra Laura Irving Mark Rosales

Rebecca Clark Melissa Iskov Theresa Russo

Sarah Cohen Chelsea Ives Alison Rutherford

Nicholas Coxon Fayyaz Khan Georgie Scanlon

Megan Ault Cullen Julia Lambert John Schauble

Emily Debney Timothy Lambert Gajan Selvarajah

Louise De Gannes Laura Lane Alanna Symons

Ken De Vries James Lavery Gemma Tiernan

Matthew Downey Kerin Leonard Dr Emma Tinning

Adam Duke Samantha Loff Alanna Trembath

Rebecca Duke Grace McCoy Dr George Vasilev

Indhia Duncan Cosima McRae Ruth Ward

Nicola Farray Emma Moffatt Phil Watson

Emma Fenby L Gopika Murthy Janet Westwood

Haylea Fitzsimmons Archana Naidu Ben Whitton

Dr Holly Foster Jacinta Nancarrow Greg Williamson

Charlotte Frew Dr Phuong Nguyen Claire Wong

Jenny Galloway Ilona Nicola Christopher Woodall

Naomi Goldwater Rebecca Olsen

Note: The Commission had a core contingent of 45 staff. This is an exhaustive list and includes staff who worked for
the Commission for short engagements and on a part-time basis. It also includes secondees who were engaged to
assist the Commission for a period of time.

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38.7  Expert Advisory

Committee appointed
As the letters patent directed, the Commission established an eight-member Expert
Advisory Committee.15 The committee brought a wealth of knowledge to the Commission,
including lived experience, and professional and sector experience with Victoria’s mental
health system.

Professor Patrick McGorry AO (Chair)

Patrick is the Executive Director of Orygen and Professor of Youth Mental Health at the
University of Melbourne. He is a world leader in mental health innovation, advocacy and
reform. In 2010, Patrick was selected as Australian of the Year. As a psychiatrist, Patrick
has worked in mental health for the past 40 years and is a prominent researcher in early
psychosis, youth mental health and clinical research more broadly.

Anne Doherty

Anne has extensive experience in leading and managing clinical mental health services, and
has a deep knowledge of clinical and corporate governance. Anne has worked in a range
of senior executive roles and has been a member of boards and state committees. She has
held leading executive portfolios at Monash Health and is a board member at the Butterfly
Foundation.

Honor Eastly

Honor is a mental health advocate who specialises in consumer engagement, lived

experience and peer workforce initiatives. Honor is a critically acclaimed podcaster
and co-founder of The Big Feels Club, a public-facing mental health resource and peer
support initiative.

Julian Gardner AM

Julian has held several senior positions within the Victorian mental health sector and public
sector. Most recently, Julian was chair of the Mind Australia board, and has previously held
positions as the chair of advisory and consultation groups for the review of the Victorian
Mental Health Act. From 2000 to 2007, he was the Public Advocate for Victoria.

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Erandathie Jayakody

Erandathie has a lived experience of mental ill health and recovery. Erandathie is a member
of the Mental Health Tribunal and an Assistant Director, Strategic Advice, Psychosocial
Disability at the National Disability Insurance Agency. She is the co-editor of the book Peer
Work in Australia: a new future for mental health.

Dr Gerry Naughtin

Gerry has had an extensive career in human services in the disability and aged care sectors,
and has a strong history of promoting consumer and carer participation in sector reform.
Gerry is the strategic adviser for mental health in the Strategic Advisers and Research
Division of the National Disability Insurance Agency, and was previously the CEO of
Mind Australia.

Distinguished Professor James Ogloff AM

James is a clinical and forensic psychologist, academic, researcher and practitioner with
extensive experience in clinical and forensic mental health. He is Executive Director of
Psychology Services and Research at the Victorian Institute of Forensic Mental Health
(Forensicare) and a Distinguished Professor and Director of the Centre for Forensic
Behavioural Science at Swinburne University.

Jim Williamson

Jim started his career as a secondary school teacher and lecturer, and has worked as a
senior policy manager and consultant in public policy. He holds several advocacy roles
impacting on local government areas in the western region of Melbourne and has an interest
in developing a mental health system with a stronger community focus.

38.8  Counsel Assisting appointed

Lisa Nichols QC was appointed Senior Counsel Assisting the Commission in March 2019. She
served until 22 October 2019, when she was appointed as a Judge of the Supreme Court of
Victoria. Stephen O’Meara QC was engaged as Senior Counsel Assisting the Commission
from 23 December 2020 until the end of the Commission. Junior Counsel Assisting, Georgina
Coghlan SC and Fiona Batten, supported the Commission for its duration.

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1 Victorian Government, Announcement: Royal Commission into Mental Health Speech, 24 October 2018, p. 4.
2 Victorian Government, Announcement: Royal Commission into Mental Health Speech, p. 5.
3 Victorian Government, Announcement: Royal Commission into Mental Health Speech, p. 4.
4 The Age, Commissioners Named in Bid to Fix State’s ‘Broken’ Mental Health System, 24 February 2019, p. 2.
5 Victorian Government, Announcement: Royal Commission into Mental Health Speech, p. 4.
6 Victorian Government, Royal Commission into Victoria’s Mental Health System—Letters Patent, 2019, para. I.
7 Inquiries Act 2014 (Vic), Part 2, Division 3.
8 Inquiries Act 2014 (Vic), sec. 12.
9 Royal Commission into Victoria’s Mental Health System, Interim Report, 2019.
10 Victorian Government, Royal Commission into Victoria’s Mental Health System—Letters Patent, para. II(b).
11 The Honourable Daniel Andrews MP, Premier of Victoria, Media Release: Statement On Extension For Royal
Commission, 5 May 2020, <www.premier.vic.gov.au/statement-extension-royal-commission>, [accessed 29
October 2020].
12 Victorian Government, Royal Commission into Victoria’s Mental Health System—Amended Letters Patent, 2020.
13 RCVMHS, Statement on Public Hearings, 19 March 2020.
14 The Honourable Daniel Andrews MP, Premier of Victoria, Media Release: Experts to Lead the Mental Health Royal
Commission, 24 February 2019, <www.premier.vic.gov.au/experts-lead-mental-health-royal-commission>, [accessed
1 September 2020].
15 Victorian Government, Royal Commission into Victoria’s Mental Health System—Letters Patent, para. IV.

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Chapter 39

The work of
the Commission

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39.1  The Royal Commission

The Commission’s task was a policy-based inquiry, with recommendations to inform the
future design of the mental health system, rather than an investigation into individual cases
or particular events. This policy focus meant the Commission could gather evidence in ways
that extended beyond traditional hearings and submissions.

The Commission’s approach to its inquiry was also informed by the complexity of its task and
the level of change to the mental health system that is required. As outlined in Chapter 2: The
Commission’s approach to reform, the Commission applied a systems change framework
to its work. Within this context, the Commission used a range of processes to develop its
understanding of the existing mental health system and to inform its recommendations
about the future system design. These processes included formal inquiry mechanisms, such
as gathering evidence through submissions and public hearings, drawing on academic
research and literature, and community engagement.

The Commission’s letters patent, which were informed by more than 8,000 community
contributions,1 asked it to ‘engage widely’.2 The letters patent also identified major population
groups for the Commission to consider in making its recommendations: in particular,
people who are at greater risk of experiencing poor mental health.3 In considering this, the
Commission committed to hear and take into account the needs of diverse communities
in Victoria.

As the Premier stated at the announcement of the extension of the Commission, ‘[f]rom the
outset of the Royal Commission, we understood that the voices of Victorians must be at the
heart of our reform.’4

The Commission made it possible for new insights about the mental health system to be heard
and incorporated into the future system’s design, by supporting continued conversations with
people with diverse perspectives, expertise and experience throughout its inquiry.

39.1.1  The voice of people with lived experience

The Commission’s letters patent required it to have regard to the ‘evidence of people with
lived experience’5 and directed the Commission to ‘follow best practice approaches to
engagement with people with lived experience, including the provision of opportunities for
them to share their experiences while recognising that many of them will need support to
disclose trauma’.6

While the Commission understands that the term lived experience is used and understood in
different ways by different people, for the purpose of this report, the Commission builds on its
interim report and refers to people with lived experience to include:

• someone who is living with (or has lived with) mental illness or psychological distress, or
• someone who is caring for or otherwise supporting (or has cared for or otherwise
supported) a person who is living with (or has lived with) mental illness or psychological
distress.7

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The Commission recognises that the needs of each group can be different, that one
individual can be in both groups, and that individuals identify in many ways.

It also recognises that there is a power imbalance when it comes to involving people with
lived experience in policy reform and system design, as described in more detail in Chapter 2:
The Commission’s approach to reform.

Ms Janet Meagher AM, an advocate for people with lived experience of mental illness,
highlighted in her witness statement that:

Often people with personal experience of mental illness have been taught that others
are the experts, that there is a professional who has ‘the answer’, knows what is best
and that there are only limited, rigid versions of the way forward.8

The Commission went further than the requirements of its letters patent to have ‘regard to …
the evidence of people with lived experience’.9 It continued to draw on the perspectives and
analysis of people with lived experience throughout all phases of its system design work,
through carefully designed engagement opportunities.

39.2  Overview of the Commission’s

engagement
As described above, the Commission engaged widely to gather evidence to inform its
findings and recommendations, including contact with the Victorian community to hear their
experiences of and suggestions for the future of the mental health system. The Victorian
community has made more than 12,500 contributions to inform the Commission’s work, in
addition to more than 8,000 submissions that shaped the terms of reference before the
work began.

All inputs the Commission has received will be delivered to the Public Record Office Victoria
at the end of the Commission. This record of the Commission’s work and contributions made
to it will include submissions, witness statements and records of meeting proceedings.

Figure 39.1 shows some of the Commission’s important event milestones.

Figure 39.2. is an overview of the Commission’s key facts and figures.

Figure 39.3 shows the Commission’s engagement across Victoria.

From late March 2020, when the COVID-19 pandemic worsened in Australia, engagements
were quickly adapted and held in various online formats. Shifting to virtual engagement
benefited many participants by removing several barriers to taking part, including eliminating
travel time and increasing the flexibility for people to participate from their homes.

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Figure 39.1:  Important Commission events

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Figure 39.2:  Facts and figures

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Figure 39.3:  The Commission’s engagement across Victoria

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39.2.1  Expert Advisory Committee

The Commission was supported throughout its inquiry by the Expert Advisory Committee,
chaired by Professor Patrick McGorry AO. The Committee advised the Commission on a
range of topics, including engagement, how to raise awareness of mental health, and the
likely impact of the Commission’s findings and recommendations. The Commission held 14
Expert Advisory Committee meetings and presented papers covering more than 30 topics
for discussion through this forum. The Committee also provided advice through individual
member meetings with Commissioners and policy staff.

39.3  Community consultations

One of the Commission’s first acts was to listen to people in communities throughout the
state. The consultations, held from 5 April to 22 May 2019, were open to everyone. More than
1,650 people attended 61 sessions in 21 locations in regional, rural and metropolitan Victoria.

A wide variety of people attended the consultations to share their experiences of living with
mental illness or psychological distress, caring for someone living with mental illness, or
of working in the mental health sector. Some came to tell of losing someone they loved to
suicide. Some had described their experiences in previous forums, while others were taking
part in a formal consultation process for the first time.

The Commission heard from people working in acute, community and specialist services,
general practitioners, private psychiatrists, allied health and other professionals, youth
workers and numerous staff working in intersecting fields, such as community health services,
housing and homelessness services, family violence, and alcohol and other drug services.
There were also people from legal and justice services, financial counselling organisations,
local councils, schools, emergency services and gambling services, as well as state and
federal members of parliament, library staff and academics.

Many participants had their own lived experience of mental illness or psychological distress,
or were families, carers or supporters. The Commission noted that people often brought
multiple perspectives, and it appreciated the diversity this brought to the consultations.

Each session ran for about 90 minutes and was guided by a facilitator, allowing
Commissioners to move around the tables and listen directly to community members. Each
table had eight to ten people, and had a Commission staff member listening and taking
detailed notes while the participants discussed three questions:

• Reflecting on mental health services, what is working well?

• Reflecting on mental health services, what is not working well?
• What needs to change to improve Victoria’s mental health services?

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The level of interest in the community consultations often meant that multiple sessions
were held in one day, and that extra rooms were required to accommodate the number of
attendees. An example of this was the Box Hill community consultation on 20 May 2019. Three
sessions were held in Box Hill, with more than 170 people coming to share their contributions
with the Commission. The pictures at Figure 39.4 and Figure 39.5 show two of the rooms at
the Box Hill Town Hall where people gathered to have their say at the consultation.

Figure 39.4:  Box Hill Consultation Room 1, 20 May 2019

Figure 39.5:  Box Hill Consultation Room 2, 20 May 2019

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The consultations were designed to give participants an opportunity to share their

experiences and ideas. Participants listened to each other and added different perspectives.
They supported each other in informal ways—making a cup of tea for someone, or offering a
tissue or a kind smile—and they often shared a sense of frustration and desperation, along
with a commitment to and hope for a better future for the mental health system.

Box 39.1:  Advice on social media ahead of

attending a community consultation

During the Commission’s consultations in 2019, a community member was a

bit unsure about coming along to one of the sessions. She took to social media
and sent a tweet to say she was booked in to attend a community consultation
but was nervous, and asked if anyone else had been involved. Several people
responded with messages of support, letting her know what to expect, describing
Commission staff as warm and welcoming and encouraging her to participate
and share her voice.

Conversations at tables allowed participants to share their experience with a smaller group,
before joining in a plenary discussion inviting participants to share their insights and ideas
for change, including any new ideas they had, with the whole group. No topic was off limits in
the small groups or in plenary sessions.

Some participants also chose to share supporting information and documentation for
the Commission to consider. These contributions became part of the Commission’s
evidence base.

Following the community consultations, the notes Commission staff had taken were
combined and analysed, and a report was produced for Commissioners describing common
experiences and important issues participants had raised in response to the three questions
outlined previously. The Commission used this information to shape its work and help it
decide on topics for the 2019 public hearings.

The Commission received feedback from participants about the community consultations,
which was taken into account as it developed further engagement activities. Specifically,
the Commission heard from some participants that they wanted a more private opportunity
to provide input, and they did not always feel safe to openly share when they were in the
same space as others. For example, some consumers provided feedback that having
dedicated ‘consumer-only’ sessions would support sharing lived experience from a consumer
perspective and would go some of the way to addressing the power imbalance outlined earlier.
People attending the consultations could also make private and confidential submissions.

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When planning other engagements, the Commission provided a range of options that
included consumer-only, family and carer-only and workforce-only spaces for conversation.

The Commission received a range of feedback on the consultation process, with some
participants saying they felt their experiences were acknowledged by the process. For some,
this was the first time they have felt this in the context of the mental health system:

[The Royal Commission] is the first time I’ve felt like I could use my intelligence and my
experience to add to the picture.10

Participation in the consultations was supported by:

• Commission staff, who were clearly identified

• peer workers from the Victorian Mental Illness Awareness Council (VMIAC), the peak
Victorian non-government organisation for people with direct lived experience of
mental health issues or emotional distress, and Tandem, the peak body for families and
friends supporting people living with mental health issues
• a professional counsellor
• a document outlining what people could expect at the consultation sessions
• an information sheet with the contact details of support services for people to take with
them after the session
• a short video of Commissioners talking about their aspirations for the Commission
• details about how to stay up to date with the work of the Commission.

39.4  Submissions
The Commission issued a media release on 17 April 2019 calling for submissions until 15 July
2019. The call for submissions was open for 11 weeks and the Commission received 3,267
submissions.11

Input was sought from the general public, and all views and ideas for change were welcomed.
Those who shared their experiences included people who had lived experience of mental
illness or psychological distress, families, carers and supporters, people who worked in the
mental health or related sectors, services, academics and members of the public with a
general interest in mental health. Many submissions covered multiple topics, concerns and
suggestions.

Figure 39.6 provides an overview of the submissions the Commission received.

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Figure 39.6:  Submissions received by the Commission

Note: Totals may not add to 100 per cent due to invalid/unknown responses. Where totals exceeded 100 per cent, these
have been adjusted to 100 per cent.

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People could make submissions in a range of formats, so they could tell the Commission
about their experience or perspective in the way that best suited them. Box 39.2 describes
one example of the flexible options for people to share their stories with the Commission.
Submissions could be made online, via mail or email, by phone, or with audio or visual
content. They could also be made by telephone with an interpreter service.

Information about how to make a submission was provided in English, Easy English and in 16
languages other than English, with priority given to the most commonly spoken languages in
Victoria and the languages of newly arrived communities.

All submissions were read and reviewed. Where people agreed to their submissions being
public, the Commission published them on its website.

Box 39.2:  The Commission provided flexible

options for people to make submissions

An older person wanted to share her story and ideas with the Commission as part
of the submission process. She said she was unable to handwrite her experience
and there was no one else to support her to do this. She did not have a computer
or the internet. Her only form of communication was her mobile phone, which she
regularly used to contact the Commission for updates.

The Commission worked with the person to find a way of making a submission
that suited her. It offered her options for listening to her story, such as talking with
a Commission staff member over the phone, coming to the Royal Commission
office to speak with someone in person, and having a Commission staff member
visit her at home. However, because she did not want to talk about her experience
in a concentrated period of time, she decided that she preferred to call after
business hours and leave her story on the Commission’s voicemail, in multiple
messages. This allowed her to make her submission over a number of evenings,
and to call at times that suited her. The Commission then transcribed the audio
recordings to capture her submission, which it published anonymously on its
website with her permission.

This process supported the person to make a submission. She was able to choose
a way to engage in the process that was flexible, accessible and made her feel
comfortable.

Some people chose to provide visual content, as a way of strengthening the points in their
written submission, as shown in Figure 39.7.

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Figure 39.7:  An anonymously published submission with pictures and diary excerpts from
when the writer was in an inpatient unit12

Diary entry 29th April: ‘I’m currently sitting in the communal area watching TV with everyone else. A new boy came in today and
he came in to solitary confinement which is pretty scary and full on. Last night the girl with anorexia was screaming and the
security guards tried to hold her and stop her from running out of here. I’m waiting for Mum to come I’ll maybe write a little later
but goodbye for now’.

The Commission’s long-form submission process took people through a structured online
questionnaire consisting of 11 questions about reducing stigma and discrimination,
preventing suicide, early intervention, and how people access, use and experience care,
treatment and support. People could answer the questionnaire alone or attach their
submission to the online form. The Commission also provided the option for people to
complete brief comments via a shorter online questionnaire that included a subsection of the
long-form submission questions.

Some submissions did both—they responded to the questions and provided additional
information for the Commission’s consideration. One submission provided a written response,
links to videos and an invitation for the Commission to attend a theatre performance, which
is described in Box 39.3.

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Box 39.3:  Innovative submission from Listening to Voices Theatre

The Commission welcomed innovative submissions to support people to share

their experiences and ideas for a future mental health system. One particularly
innovative submission came from Listening to Voices Theatre, based out of
Gateway Health in Wodonga. Listening to Voices Theatre is a program in which
people with lived experience use theatre methods to both discover the need
to speak, and to speak about things often unspoken. The performers are also
advocates in this way, working hard to support those watching in the community
and the workforce to have a better understanding of lived experience. In addition
to their written submission, Listening to Voices Theatre invited the Commission
to watch a performance created and performed by people with lived experience,
called Hero of Myself.

On 6 December 2019, a Commission staff member went to Wodonga to attend

Hero of Myself.

The performance aimed to show audiences the many realities of living with
mental health challenges, in the hope that the audience will gain a better
understanding of people’s lived experiences, build empathy and reduce stigma.

The performance included several short scenes on themes such as:

• accessing and navigating the mental health system

• trauma
• understanding and listening to voices that other people cannot hear
• diagnosis
• stigma.

The performance showed different experiences and perspectives to give a sense

of how lived experience is unique to an individual. While the focus was on people
experiencing mental illness or psychological distress, families and carers were
also portrayed in the performance.

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Listening to Voices Theatre explained the philosophy behind the performance in

its submission to the Commission.

The work honours the lived experiences of the performers, placing them as
the experts and exploring what works and what urgently needs attention.
Through their storytelling, powerful and confronting, they are stimulating
very important dialogue.39

After the performance, the Artistic Director asked the audience to call out words
that reflected their impressions of the performance and how it made them feel.
Some of the reflections and words called out were ‘inspired’, ‘amazed’, ‘strength’,
‘encouraged’ and ‘talented’.

Listening to Voices Theatre has been using this unique creative form of advocacy
since 2016.

Photo credit: Irene Metter

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39.4.1  Processing and publication of submissions

All submissions were read and handled in accordance with a protocol on processing and
publication of submissions. If a submission indicated that someone may be distressed and
without other supports, and they had provided their contact details, the Commission’s
community engagement team reached out to offer them help in connecting to services and
supports in their local area. This work also included connecting people with peer and other
supports, such as VMIAC or Tandem.

The Commission also supported people sharing their experience with the Commission
to connect with the Mental Health Complaints Commissioner, if they wanted to seek an
individual remedy for a complaint about a mental health service.

Names of people other than the person who made the submission were generally redacted—
removed—to protect privacy. The protocol also detailed the Commission’s strict checking
process. Before publishing any submission, two different staff members checked the content
to make sure the file title matched the contents of the submission. They also checked the
submission against a list that outlined which category each submission belonged to—public,
anonymous or restricted—to prevent the accidental publication of confidential material.
People were notified about the publication of their submission in advance.

39.5  Site visits

Commissioners visited services and organisations across Victoria including inpatient units,
community health settings, prisons, courts and Aboriginal health services. These visits gave
Commissioners opportunities to see the diversity of physical environments where mental
health treatment, care and support is provided and the range of service models in practice,
and were valuable inputs into the Commission’s deliberations. The Commission’s Chair also
visited New Zealand to examine more innovative environments for treatment, care and
support. Figure 39.8 was taken during the Chair’s visit to Piri Pono, New Zealand in 2019.

There were some site visits planned for the later stages of the Commission’s work in 2020,
but these could not occur due to COVID-19 restrictions. Instead, Commissioners had online
meetings with a range of different service providers to discuss practice and service delivery
models, and the benefits and limitations of particular facilities. Box 39.4 describes one of
these online meetings.

A list of site visits is at Appendix C.

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Figure 39.8:  Piri Pono, New Zealand

39.6  Individual meetings

The Commission held numerous meetings with a range of Victorian, national and
international professionals, including lived experience experts, during its engagement
process. It sometimes met with individuals more than once, where further examination
of issues was required. These meetings helped the Commission to develop and refine its
thinking, and informed its decision making.

Academics, leading professionals and consumer leaders also provided input to the
Commission in various ways, including through public hearings and witness statements,
roundtable meetings, and by contributing information and supplementary submissions. The
Commission benefitted greatly from this expertise.

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Box 39.4:  Adult Mental Health Rehabilitation

Unit – Secure Extended Care Unit

One of the Commission’s meetings was with people at the Adult Mental Health
Rehabilitation Unit – Secure Extended Care Unit (AMHRU–SECU) in Sunshine.
Due to COVID-19 restrictions, the meetings took place via video conference. The
Commission met with the unit’s senior leadership team in a meeting chaired by
a Commissioner. The Commission also met with three people using the AMHRU’s
services and two AMHRU carers.

The meetings with the service users and carers focused on what they liked about
the environment and what they thought could be improved. The conversations
helped the Commission understand how both groups of people experience such
an environment.

A nurse attended with the service users to provide support and service users were
given the opportunity to speak to Commission staff without the nurse present.
The sessions were recorded with the service users’ and carers’ consent.

39.7  Public communications

The Chair of the Commission led its public communications, engaging with media at distinct
points during its inquiry—at the commencement of the Commission, at the point of calling
for submissions, at the tabling of its interim report, at the announcement of the Commission’s
extension, and at the tabling of its final report. While the Commission monitored media,
including social media, daily, so that it maintained an understanding of the public discourse,
the Commission did not itself run public commentary on issues that may pre-empt its
consideration of all the evidence and its final deliberations.

To help people to stay informed about the Commission’s work, it developed and distributed
its own communications and updates to the public through a range of digital formats. Its
website, for example, featured the most important information about the Commission,
including its letters patent, the interim report, and submissions and witness statements that
contributors had agreed to let the Commission publish.

Figure 39.9 shows that the Commission’s website received more than 488,400 views and
195,800 visits from more than 98,200 users as at 31 December 2020.

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Figure 39.9:  Visitors to the Commission’s website as at 31 December 2020

As well as keeping its website up to date, the Commission used Twitter to communicate and
promote its work, including giving details about its public hearings, live-tweeting important
events, and publishing witness statements and other content, including videos, media
statements and updates.

The Commission also published and promoted more than 25 different videos on its YouTube
channel, gaining more than 10,000 views.

People interacted with and shared content the Commission published on social media
with enthusiasm, particularly for milestones such as public hearings, the publication of
submissions and statements, and the launch of the interim report. The Commission had more
than 1,800 Twitter followers at the end of its inquiry.

Another way the Commission updated the public on its work was through regular digital
newsletters. People could subscribe to the newsletter on the Commission’s website or by
calling the 1800 number, and many did: the newsletter went out to almost 2,000 subscribers.

The Commission continued to interact with people with lived experience by holding Q&A
(question and answer) sessions with VMIAC, Tandem and the Youth Affairs Council Victoria
(YACVic). During these sessions, Commissioners responded directly to questions from people
with lived experience from across Victoria, and detailed the Commission’s work to date. The
shift to digital meant that sessions held after April 2020 were able to be easily recorded and
made available online for viewing by a wider audience.

Figure 39.10 was taken during a Q&A forum with VMIAC in 2020.

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Figure 39.10:  VMIAC Q&A forum in February 2020

39.7.1  Correspondence
The Commission received a range of correspondence, which supported it in all stages of its
work. This included correspondence from people providing or seeking extra information from
the Commission. In total, the Commission received more than 1,300 items of correspondence.

All correspondence was read by a Commission staff member. The Commission valued the
time and care people took to send correspondence. By responding with a similar amount of
time and care, the Commission hoped people would feel they had been heard and that their
contribution would continue to inform the Commission’s work.

39.7.2  Telephone support line

The Commission also staffed a 1800 telephone support line, which:

• gave people information about the Commission

• connected people to services and bodies, including to the Mental Health Complaints
Commissioner if people wanted to complain about services or treatment they
had received
• gave people an opportunity to talk the Commission through extra information they
wanted to provide
• enabled the Commission to update people on its work, including how to obtain
information and connect further with the Commission.

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Commission staff also provided a supportive contact point if people wanted to talk about
their concerns or experiences with mental health and the mental health system.

In total, the Commission received more than 2,000 telephone calls.

Commission staff managed and responded to correspondence and calls to the support
telephone line by following Commission protocols that included the:

• Referral protocol between the Commission, the Department of Health and Human
Services, Melbourne Health and Monash Health
• Referral protocol between the Commission and the Victorian Fixated Threat
Assessment Centre
• Personal story collection protocol
• Protocol on public communications
• Privacy policy.

39.8  Public hearings

In July 2019, the Commission conducted 19 days of public hearings across three locations
to understand the important issues within Victoria’s mental health system. All four
Commissioners were present to hear the witnesses’ evidence. A list of witnesses is at
Appendix C.

While this Royal Commission was asked to run a policy-focused inquiry, the public hearings
took a legal format, and had the benefit of allowing evidence to be publicly presented and
tested through examination by Counsel Assisting. The Commission’s policy staff worked
closely with Counsel Assisting to ensure the hearings were able to effectively explore
important policy questions.

Witness statements provided background, history and context, allowing for a depth of
understanding that could be explored during the hearings. Counsel Assisting’s questions
enabled further analysis of the evidence. The approach Counsel Assisting took to questioning
supported witnesses to put their views forward.

On the first day of the hearings, the Commission showed a short animated video it
had prepared about the current Victorian mental health system. The video provided
Commissioners, Counsel Assisting, witnesses and those attending the hearings or watching
remotely, with a shared context for what would be covered in the hearings and why. This
video was also shared through social media channels and viewed more than 1,500 times.

Figure 39.11 is of the public hearings taking place at the Melbourne Town Hall in July 2019.

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Figure 39.11:  Public hearings at Melbourne Town Hall in July 2019

During the hearings, the Commission heard from witnesses about issues and questions
relevant to its terms of reference contained in the letters patent. As noted above, hearing
topics were informed by what the Commission had previously heard. Witnesses included
consumers and carers, service providers, and workforce and government representatives.

The topics covered were:

• stigma
• prevention and early intervention
• accessing and navigating the mental health system
• carers and family
• supports for and the needs of particular groups, including rural communities,
Aboriginal people, LGBTIQ+ people, and culturally and linguistically diverse communities
• community resilience
• suicide prevention
• prioritisation and delivery of mental health services.

To support the Commission’s focus on rural and regional mental health needs, a regional
hearing day was held in Maryborough in the Central Goldfields. A day-long hearing
that focused on the needs of Aboriginal people in Victoria was held at the Aborigines
Advancement League in Thornbury.

Witness statements and transcripts from the hearings are available on the Commission’s website.

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Although most of the hearings were open to the public and livestreamed, the evidence of
some witnesses was the subject of a restricted publication order. This meant that identifying
information about a witness could not be published on the Commission’s website. On a
small number of occasions, the hearings were closed to the public to protect the privacy of
witnesses and their families.

39.8.1  Witnesses
The Commission heard from 99 witnesses during the 2019 hearings. Thirty community
witnesses spoke about their lived experience—18 from personal experience and 12 from the
perspective of being family members, carers and supporters of people living with mental
illness or psychological distress. The Commission heard from mental health professionals,
police officers, paramedics and leaders in research, service management and education.

Witnesses outside of government and mental health services were also supported by the
Commission’s Counsel Assisting to make their statements.

As with the community consultations, several witnesses brought multiple perspectives to

their evidence, having worked in the mental health system and also having lived experience.
Witnesses prepared written statements, apart from one witness, who prepared a video.

This video statement reflected the Commission’s commitment to supporting people—

whether they were making submissions or attending hearings as witnesses—to have their
voices heard in whatever way suited them best.

The support that the Commission gave witnesses extended to interactions with the media.
Throughout the hearings, there was considerable media interest and coverage. Metropolitan
and regional media attended each day and were given a dedicated space with screens and
audio feeds. Commission staff acted as a liaison between witnesses and media to support
individuals to share their stories, and to encourage consistent and accurate media coverage
about mental health.

The Commission also created some short videos featuring witnesses to promote and
highlight content from the public hearings, and to give a sense of the evidence received to
those who did not watch the hearings. These videos were promoted on social media and
online, and shared with those involved for distribution.

39.8.2  Supporting community witnesses

The Commission took particular steps to support community witnesses who were sharing
their lived experience. These steps were:

• sharing videos about what it was like for witnesses to give evidence before the
Royal Commission into Family Violence in formal hearings, featuring the generous
contribution of two witnesses with lived experience of family violence

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• allocating a consistent point of contact in the Commission’s community engagement

team to the greatest extent possible. The community engagement team’s role included
providing witnesses with information about what to expect, giving them an opportunity
to walk through the hearing venue in advance where possible, meeting them on the
day, and checking in with them afterwards
• offering witnesses support when dealing with media enquiries
• offering a session with counsellors engaged by the Commission
• developing factsheets for witnesses about what to expect, and about things to consider for
carers and supporters, so that witnesses had written information to take away with them
• explaining options for community witness statements to be published under a
pseudonym, in the person’s first name only, or kept confidential to the Commission, to
protect the person’s privacy, or to protect sensitive information
• providing dedicated seating so that support people, including family and friends, could
sit closest to the witness while they were giving their evidence.

The Commission’s efforts to support witnesses were well received, with the Commission
continuing communications with community witnesses throughout its duration:

Thank you for your wonderful words and thank [you] for all of your wonderful support.
[Y]our team had been so good to me throughout this whole experience. It is what any
mother would do and by knowing how painful it is for another mother to go through a
mental health journey and suicide, that is why I did the Royal Commission.13

39.8.3  Accessibility of hearings

To support the accessibility and inclusivity of the public hearings, they were held at
accessible venues and were open for the public to attend. They were also streamed online
and transcripts were published on the website within 24-hours after each hearing. The
Commission invited those who required additional supports to make these known to the
Commission beforehand so that they could be arranged.

The Commission took care to provide detailed information on its website for those who wanted to
attend the hearings, putting thought and care into trying to make people feel safe and welcome.

Actions to support this included:

• preparing a factsheet for the general public that outlined what to expect at a Royal
Commission hearing and a sense of what would happen on the day
• developing a protocol outlining how the Commission wanted people to be treated and
welcomed and discussed this with venues in advance of hearings
• having Commission staff present to welcome and guide people at access points
• providing physical security to ensure everyone’s safety, while maintaining a welcoming
atmosphere
• allocating an extra, less-formal space for people to watch the livestream, without
having to be in the hearing room: this was a room where people could talk to each other
and help themselves to refreshments—colouring books for children were also provided

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• providing a dedicated space for media, which allowed Commission staff to act as a
liaison with witnesses first to confirm their wishes to speak with media, and to provide
support before and after any interviews
• providing trained counsellors, and a private area for conversations with them at the
hearing venues: this included counsellors from the Victorian Aboriginal Health Service
at the hearing day at the Aborigines Advancement League
• providing childcare support at the Aborigines Advancement League
• providing refreshments, ranging from tea, coffee and biscuits at the Melbourne Town
Hall, through to a catered lunch at Maryborough and the Aborigines Advancement
League, in recognition that food outlets were not always available or accessible.

39.8.4  Hearing incident management protocols

Hearing incident management protocols were established to support the conduct of the
Commission’s public hearings. The protocols set out that the Commission’s primary duty was
to the safety of participants at its hearings, and to provide people with the opportunity to
give and hear the evidence before the Commission.

The protocols set out procedures to de-escalate situations; for example, if there was violence
or threat of violence. The procedures outlined circumstances under which the Commissioners
and audience would be removed from the hearing venue, and when police would be called
(this would only be if there was an emergency, not if someone merely disturbed proceedings).

In line with the Commission’s commitment to support people to express their opinions, the
protocol specified that while people may be asked to leave a hearing if they were disrupting
it, there should be no intent to limit people’s ability to express themselves in a way they chose.

39.9  Community sentiment survey

The Commission engaged a market research company to conduct a community sentiment
survey. The survey was conducted to help the Commission understand current attitudes and
perceptions about people living with mental health challenges, and about Victoria’s mental
health system.

The company surveyed more than 3,000 Victorians in July 2019. The survey was
complemented by five focus group discussions across Victoria, involving 46 people: two
groups in Richmond, and one each in Frankston, Traralgon and Warrnambool.

A summary of the findings was published on the Commission’s website and Figure 39.12
details the survey respondent characteristics.

The information from this survey informed the Commission’s assessment of issues outlined
in its interim report. The content also helped to shape the Commission’s work in 2020 on
stigma, discrimination and the role of communities, places and sectors in supporting better
mental health.

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Figure 39.12:  Survey respondent characteristics

39.10  Targeted roundtables

The Commission held 17 targeted roundtable meetings, chaired by a Commissioner, from May
to December 2019.

These roundtable meetings were used to explore the diverse needs of Victorians, with a
focus on the needs of Aboriginal people, LGBTIQ+ people, culturally and linguistically diverse
communities, people with neurodiversity and intellectual disabilities, older people and young
people. They were also used to examine intersecting service systems, including housing,
alcohol and other drugs, and the justice system. A full list of roundtables and attendees is at
Appendix C.

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Box 39.5:  Rural and regional input

The Commission valued the contribution and voices of rural and regional
Victorians, and hearing about the unique challenges and opportunities these
communities face. The Commission visited specific communities and connected
with services, community leaders and people with lived experience, supporting its
commitment to rural and regional perspectives.

Consultations were held in Mildura, Swan Hill, Bendigo, Ballarat, Hamilton,

Warrnambool, Geelong, Warragul, Sale, Seymour and Shepparton. These
consultations helped the Commission to understand the mental health needs and
experiences of the mental health system from people living in rural and regional
communities, and how these differ between large regional centres, smaller
country towns and dispersed rural farming communities.

In mid-2019, the Commission held two regional roundtables in Traralgon and

Maryborough, where Commissioners connected with local organisations,
including health services, councils, schools, police and Aboriginal services. The
local roundtable in Maryborough was followed by a hearing day on 15 July 2019
that was dedicated to examining the mental health needs and the operation
of the mental health system in rural and regional communities across the
state. The Commission heard from multiple witnesses across 2019 and 2020
providing regional and rural perspectives. In addition, more than 15 per cent of
all submissions received by the Commission were from people in regional and
rural Victoria.

While COVID-19 restrictions meant that plans for more hearing days and
roundtables in rural and regional locations in 2020 had to be revised,
arrangements were made to continue with online roundtables with communities
in East Gippsland and north-eastern Victoria.

Rural and regional communities were involved in the Commission’s human-

centred design activities—detailed later in this chapter—with focus groups
held in Wangaratta and Bairnsdale. A number of people with lived experience
from rural and regional areas were supported to attend human-centred design
activities held in the Melbourne CBD.

Participants from rural and regional services were invited to attend topic-
based roundtables by travelling into the city, using technology to participate, or
responding to written questions, instead of attending. Moving to digital delivery
also removed travel as a barrier for participation in focus groups, and enabled
people who may not otherwise be able to be involved to take part—the same was
true for roundtables.

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39.11  Personal story collection

Personal stories focus on real-life experiences of individuals, families, carers and supporters,
and the mental health workforce, and help build understanding of the challenges of the
current mental health system and aspirations for the future.

Commissioners and Commission staff read personal stories to understand the current
system and develop recommendations. Personal stories provided important input into the
Commission’s policy design and research, by detailing the realities of service delivery from
a variety of perspectives and the practical implications of existing policy decisions. The
Commission collected stories from more than 100 people from August 2019 to November 2020
and documented what people would like to see changed in the system.

A selection of personal stories was published in the Commission’s interim report and personal
stories are an important feature of this final report. To ensure that people were comfortable
with the final form of any story selected for publication in one of the Commission’s reports,
the personal stories protocol outlined a process for checking this with them.

The Commission also collected personal stories from a range of other sources. For example,
the Commission received stories directly from community members, and from peak bodies
and services. In addition, the Victorian Government provided funding to several organisations
to assist them to provide stories to the Commission, including VMIAC, Tandem, Victorian
Aboriginal Community Controlled Health Organisation (VACCHO), Mental Health Legal Centre
and Victoria Legal Aid.

These materials have been shared with Commissioners and policy staff to inform their
analysis of current issues, and to test whether ideas for change may have made a difference
to their situation:

It was good to talk to you. We had the sense that you were really listening to us, which
was most heartening as it hasn’t happened much with the health professionals whose
job has been to help our son. So we appreciated it.14

I’m only just learning the power of my story, I thought it was just very ordinary ...
Somebody said to me once … ‘once you are heard, you begin to heal’ and I think that is
really important because a lot of these experiences are very isolating ... So to finally be
heard and listened to, I can now heal.15

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39.12  Interim report

The Commission’s interim report was presented to the Governor of Victoria on 27 November
2019 and tabled in the Victorian Parliament on 28 November 2019. While policy analysis and
research continued throughout the Commission’s inquiry, the core writing for the interim
report took place from August to October 2019.

The interim report was accompanied by an executive summary, Easy English outline and
a short animated video outlining the purpose of the report and key recommendations. The
video received more than 2,200 views.

The interim report was an important first step towards reforming the mental health system,
making a number of priority recommendations. These changes were aimed at addressing urgent
problems and preparing the foundations for further reform. The interim report highlighted the
scale of change required and foreshadowed that a comprehensive set of recommendations for
transforming Victoria’s mental health services will be presented in this final report.

On 28 November 2019, the Commissioners led a media doorstop event on the steps of Parliament
House to launch the interim report. On the same morning, the Commission held a public launch
at the Melbourne Town Hall with almost 200 attendees, including community witnesses and
representatives from mental health services, peak bodies and government departments.

The Commission wanted the interim report launch to replicate the feel of the public hearings:
welcoming and inclusive. Therefore, similar thought and care went into preparations for the
launch. The Commission formally presented the report and answered attendees’ questions.
The launch was recorded and made available online, along with the Chair’s opening remarks
and presentation slides. The event shown in Figure 39.13 was also live-tweeted via the
Commission’s Twitter account.

Figure 39.13:  Interim report launch at Melbourne Town Hall on 28 November 2019

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Box 39.6:  Hearing from Aboriginal

people, communities and services

The Commission engaged Ms Nicole Cassar

to advise on its consultation with Aboriginal
people, services and communities, and to
help examine how the social and emotional
wellbeing of Aboriginal people throughout
Victoria can be improved.

On 16 July 2019, the Commission held a day

of hearings at the Aborigines Advancement
League, which focused on the needs of
Aboriginal people. The Commission heard
about the importance of understanding
that Aboriginal concepts of mental health
and wellbeing are holistic, and shaped
by connections to culture, land, extended
kinship, ancestors and spirituality.
Aunty Di Kerr on 16 July 2019

The Commission is grateful to have been welcomed to country

by Aunty Di Kerr, an Elder of the Wurundjeri people of the Kulin nation.

Aunty Nellie Flagg, an Elder and a Taylor-Charles, whose traditional countries are
Wemba Wemba, Dja Wurrung and Boonwurrung, was the first witness to appear before
the Commission that day. She reflected that, ‘when Aboriginal people talk about our
health, we don’t do it in isolation. Mental, physical and spiritual health is holistic. We
need not only to treat the person who is being damaged, but their families too.’16

Before publication of the Commission’s interim report, the Chair of the Commission
hosted several roundtables with leaders of Aboriginal services and people who had
appeared before the Commission as witnesses at the Aborigines Advancement League.
The Commission received compelling evidence from Aboriginal witnesses and services,
which recommended expanding multidisciplinary models of care that apply the
Aboriginal concept of social and emotional wellbeing. Social and emotional wellbeing
means being resilient, being and feeling culturally safe and connected, having and
realising aspirations, and being satisfied with life.17

Aboriginal leaders and senior representatives from Aboriginal organisations told

the Commission that communities have been calling for self-determined social and
emotional wellbeing models of care for decades so that Aboriginal people themselves
can provide services promoting their social and emotional wellbeing. It was action, not
more consultation, that was needed.

These conversations led to the Commission bringing forward its recommendation

about Aboriginal social and emotional wellbeing to its interim report.

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In that report, the Commission recommended that the Victorian Government expand
social and emotional wellbeing teams throughout Victoria, and that these teams be
supported by a new Aboriginal Social and Emotional Wellbeing Centre.

The Commission appreciated the attendance of Aboriginal services and organisations at

a range of roundtables, as it explored the broader mental health system design, including:

• examinations of housing
• the needs of older Victorians
• mental health services for children and young people in the youth justice system
• courts
• criminal justice services
• forensic justice services
• practitioner regulation.

The Commission was grateful for the attendance of Aboriginal organisations and
community members at regional roundtables in Traralgon, East Gippsland and
north‑eastern Victoria.

The Commission also held dedicated focus groups with carers who identify as
Aboriginal, and appreciated the assistance of the Victorian Aboriginal Legal Service
in identifying Aboriginal participants who have experience of mental illness and the
criminal justice system for the focus groups.

The Victorian Government also funded VACCHO to consult and support the
Commission’s work. This consultation took place in 2020 and resulted in Balit Durn
Durn: Strong brain, mind, intellect and sense of self, a report to the Commission that
was delivered in October 2020.

Jill Gallagher AO, CEO of VACCHO, said of the Balit Durn Durn report:

For the first time in history, Aboriginal leaders, organisations, people, families,
carers, and communities were given the opportunity to have their voices and
experiences included in a redesign of the mental health system through the
Royal Commission into Victoria’s Mental Health System.

This report explores the power of Aboriginal culture. It outlines ways to build strength,
resilience, connectedness and identity in Aboriginal people and communities to
create essential pathways for fostering positive mental health and wellbeing.18

The Commission thanks the many Aboriginal people who contributed to its
consultations and to the Balit Durn Durn report. People contributed with courage and
generosity, often sharing their difficult experiences during the COVID-19 pandemic, and
over periods of mourning in the community.

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39.13  Phase 1 of human-centred design

Many royal commissions end their public engagement after community consultations,
submissions and public hearings. However, the Commissioners gave deep consideration to
three important factors:

• the transparency of process expected of royal commissions conducted under

the Inquiries Act 2014 (Vic) to ensure public confidence in its findings and
recommendations
• the Commission’s commitment to elevating and keeping the voice of people with lived
experience at the centre of its work
• the nature of this Commission—making recommendations for the future of Victoria’s
mental health system.

To support the nature and ambition of its task, Commissioners expanded the typical royal
commission model of engagement to include participation in the process of designing the
new mental health and wellbeing system.

The Commission engaged an external consultant to adapt elements of a method called

human-centred design to support the Commission’s engagement process. The Commission
undertook two phases of human-centred design.

Human-centred design is about defining and solving problems. It puts those experiencing a
problem at the heart of the design process by working with them to come up with solutions. It
provides a ‘powerful alternative philosophy for systems design, and broader educational and
societal development’.19

From November 2019 to June 2020, the Commission undertook the first stage of its human-
centred design approach. The focus groups were held in Wangaratta, Bairnsdale, Traralgon,
Frankston and Melbourne. The Commission organised and ran focus groups in November
and December, which were facilitated by the external consultant who had adapted the
methodology. From December to June, Commission staff ran focus groups, with external
facilitation engaged at times to support participation.

The Commission worked closely with VMIAC, Tandem and a range of other services, to identify
and support participants for the human-centred design sessions. In response to feedback
from community consultations, and in discussion with Cath Roper, Consumer Adviser to the
Commission’s CEO, focus groups were split into separate consumer and carer sessions. This
was intended to provide a dedicated and safe space for open discussion about the difficulties
with the current system and aspirations for the future.

To assist participation, the Commission had a support person at every session and—
depending on whether the session was for consumers, families, carers or supporters—a peer
support worker from VMIAC or Tandem. Participants were also welcome to bring their own
support person.

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Participants and focus group locations were chosen to reflect a mix of experiences of mental
illness or psychological distress and caring, ages and geographic location. The range of
experiences covered included experience in inpatient services, clinical settings, youth mental
health services, aged mental health services, and experience of mental illness and alcohol
and other drug services.

The Commission also held a series of dedicated human-centred design focus groups with
people who had experience of mental health illness or psychological distress and the
justice system:

• adults with experience of forensic or justice mental health services

• Forensicare Consumer Advisory Group
• men over 25 years old with experience of mental illness and recent experience of the
justice system
• young men over 16 years old with experience of mental illness and recent experience of
the justice system, including youth justice
• women over 25 years old with experience of mental illness and recent experience of the
justice system
• young women over 16 years old with experience of mental illness and recent experience
of the justice system, including youth justice.

Box 39.7:  Justice focus groups

The Commission heard from 36 people across six focus groups, who had
experience of mental illness and recent experience of the criminal justice system.
The sessions were interactive and accessible—a high level of literacy was not
required, participants could request interpreters and bring their own support
people, and venues were in central locations close to transport. A graphic
recorder captured the conversation using a range of pictures, images and key
words. Refreshments were provided, and created an informal and welcoming feel.

Nicole Cassar, the Commission’s Aboriginal community engagement adviser, led

participants through the sessions. A male facilitator supported the sessions with
men. A female facilitator supported the sessions with women.

By using human-centred design methods the expertise of people with lived

experience, their lived knowledge and analysis was highlighted for the
Commission.

I don’t have complex needs … I just have to navigate a complex system!20

In jail, the psychiatrist changed every six months. So, every six months, you’d
have to go through your backstory, your origin story. Again. I wouldn’t do
that. I tell them, read the files. I got sick of repeating my life story.21

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The Commission brought various materials that summarised some of what it had already
heard to these focus groups, to test its understanding of the issues and barriers people had
experienced in the mental health system. The materials included diagrams of the current
system experience, and statements about challenges consumers and carers had shared
about their experience with the mental health system.

The Commission wanted the focus groups to be a positive experience for participants,
despite the conversations centring on difficulties and challenges with the existing mental
health system. The Commission worked hard to adapt and deliver the methodology in a way
that was respectful and considerate of people’s differences, experiences and circumstances.

Figure 39.14 shows participants in human-centred design activities in Wangaratta and

Melbourne in 2019:

I found the HCD [human-centred design] session last year incredibly powerful and
gained some new friends from that group of people. I was terrified of participating but
found the participants, Royal Commission staff … and the whole process incredibly
supportive, so the experience was a very positive one.22

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Figure 39.14:  Participants in human-centred design activities, Wangaratta and Melbourne,

19 November 2019 and 10 December 2019.

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Each session ran for up to two and a half hours, and were audio recorded and transcribed.

Focus group conversations were captured by a graphic recorder who used a variety of
pictures, words and symbols to create a record of the key things that were discussed on a big
piece of paper, referred to as a canvas. The canvases, detailed notes and transcripts were
provided to Commissioners and Commission staff to support the development of ideas and
decision making.

Stories and quotes used by the Commission from the session were kept anonymous.

A list of phase 1 and 2 human-centred design activities is at Appendix C.

Box 39.8:  Informal supports and the Commission’s activities

Participants in the human-centred design focus groups were most often

strangers to each other, coming together to share their stories, commonly about
how the mental health system had let them down. While this can be a confronting
experience, it was also an opportunity for people to connect and provide informal
peer support. This happened in several ways over the two phases and 53 sessions.
The following is a description of some of those moments.

On a Saturday morning, a group of young carers from across the state came
together in the Melbourne CBD to talk about their specific challenges and
aspirations. For some of these young people, it was their first time being part of
focus group, while others were young leaders in the advocacy space. The group
was a revelation for some participants, who exclaimed that they did not know
there were so many others with the same or similar experience as them. The
planned two-hour focus group went for closer to three hours, with conversations
continuing after the session formally ended. The young participants made
connections and started a WhatsApp group to continue the conversations and
support to each other.

Another group created a virtual book club while connecting in an online

focus group. Participants were able to quickly get their favourite books from
their bookshelves and make recommendations to each other. They used the
technology to show the covers of the books, and the chat function to share book
titles and author names. They shared their thoughts on the books they were
recommending and created reading lists for each other.

An insights report from the phase 1 human-centred design process was prepared and
presented to the Commissioners by external consultants in January 2020. It provided detailed
analysis of themes from the focus groups held in November and December 2019. The analysis
in the report was used by the Commission to inform and shape options for the design of the
future mental health system.

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Frontline workforce human-centred design sessions complemented phase 1 of the design

process. Four separate sessions were held with a total of 31 frontline staff, from the peer and
lived experience workforce, nurses, psychiatrists and clinical psychologists, and allied health
professionals. These sessions, facilitated by Commissioner Dr Alex Cockram, took a similar
approach to the consumer and carer sessions, using the same tools and a survey, to reflect
and refine what the Commission had heard from across the mental health and supporting
workforces.

The session with the peer and lived experience workforces was co-facilitated by a lived
experience expert. The Commission engaged an independent peer support person to sit in on
the session and provide supervision and debriefing as needed for those attending the focus
group. One participant observed:

I am very impressed with the integrity of the Royal Commission and it gives me a lot
of hope for the future of mental health. I hope this process will enable us to help many
people, to overcome barriers and prepare Australia for future challenges. I am grateful
for everyone’s efforts. Thank you.23

Box 39.9:  Impact of COVID-19 and how the

Commission moved to digital engagement

On 19 March 2020, the Commission took the precaution of cancelling or

postponing planned in-person engagement activities due to the COVID-19
pandemic. This included cancelling its second and final round of public hearings.

The public hearings had been scheduled to start in late-April 2020 and to run
for four weeks—during the anticipated peak of the first wave of COVID-19 in
Melbourne. The scheduled commencement of the Commission’s hearings, a
few weeks after isolation measures were first introduced, did not allow time for
alternative hearing formats to be put in place that would both ensure safety and
support the smooth participation of Commissioners, Counsel Assisting, witnesses,
lawyers for witnesses and support staff.

This was not a decision made lightly. Consideration was given to a range of
options to progress the second round of public hearings, while also managing the
logistics and risks associated with COVID-19, which were still emerging, including:

• how isolation measures and restrictions would impact the various

organisations and individuals required to progress the hearings
• access to and availability of reliable technology
• availability of key witnesses working on critical responses to COVID-19 in
government and in health services
• the implications for meeting the Commission’s original timeline for delivery
of the final report of 31 October 2020.

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The Commission considered the level of uncertainty and heightened caution

across the community and decided it was possible for the Commission to obtain
the evidence required without the second round of public hearings.

As well as cancelling the hearings, the Commission cancelled four focus groups
with lived experience participants. All participants were invited to share
their personal story with the Commission via a one-on-one phone call with a
Commission staff member, or via email or mail.

Four focus groups planned with workforce participants were postponed and
delivered via an online format in May and June 2020.

Within a week of cancelling or postponing face-to-face engagements, the

Commission had committed to, and begun planning for, engagement to continue
in a digital format. This involved researching and testing online platforms, while
considering IT access and equity.

The Commission also put in place a digital process to collect witness statements
from people who had been scheduled to give evidence at the Commission’s 2020
hearings. This process is outlined in section 39.14.

The move to digital delivery extended to Commissioner meetings, which were

adapted to an online format. More than 30 Commissioner meetings were held
online during a peak period of decision making. Commissioners moved to online
meetings from Thursday 26 March 2020.

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Commission staff rapidly and creatively found ways to continue participation

remotely. Within five weeks of cancelling or postponing face-to-face activities,
invitations were sent to participants for engagements taking place from May
2020. Through the shift to digital engagement, the Commission identified new
ways of working together and new opportunities for engaging with people.

Between May and October 2020, the Commission held:

• 37 online roundtables with 372 participants

• four online Q&A sessions with more than 300 participants
• 32 online focus groups with 200 participants
• 26 online meetings between community witnesses and Commissioners to
discuss their witness statements
• eight online panel hearings with 25 participants
• two online community workshops with 31 participants.

The move to more flexible, online participation helped many people engage with
the Commission. For example, Q&A sessions between Commissioners and families
and carers were attended by 70–90 people, rather than the 30 or so who may
have been able to attend a similar meeting in the Melbourne CBD.

While physically distanced, many witnesses with lived experience had one-on-one
conversations with a Commissioner that were more personal and direct than the
experience at a public hearing.

The Commission assisted people to build their skills and knowledge using digital
technology, offering every person invited to an online lived experience focus
group and workshop the opportunity to test the technology with Commission staff
prior to the session. This meant that participants entered sessions confident that
they could actively take part. If technology or an internet connection failed during
online engagements, the Commission contacted participants to offer technical
support, and to invite them to share anything they may not have been able to
share in the session.

All participants were offered an opportunity to send through any other thoughts
or information related to the session in the days after their involvement, via
phone, email or mail.

While online participation is not suitable or accessible to everyone, the

Commission observed that these processes made participation easier for some
people, who could take part from the comfort of their own homes. It also made
access to focus groups, roundtable and workshops more equitable for those in
rural and regional Victoria, and for those living with physical disabilities.

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39.14  Collection of witness statements

The Commission collected a total of 154 witness statements from people who had been
scheduled to give evidence at the Commission’s 2020 hearings, including statements
from 43 people with lived experience—29 people with lived experience of mental illness
or psychological distress and 14 family members, carers or supporters.

Community witness statements were collected with the support of a Commission staff
member as a consistent point of contact. This support evolved based on feedback from the
2019 hearings: for the 2020 hearings, the Commission gave witnesses the option of having
a preparatory or debriefing session with a counsellor or allied health support person of
their choice. This was in addition to the offer of support from a psychologist engaged by
the Commission.

People giving evidence from the perspective of their lived experience and lived expertise
were offered a one-on-one online meeting with a Commissioner to talk about their witness
statement in more detail. The online meetings showed the ways that people adapted to and
used digital formats.

Through the online meetings, witnesses and Commissioners shared parts of their lives,
meeting from their homes, which brought a personal flavour to the conversations. There were
pictures hanging on walls, shelves of books and boardgames, and the sights and sounds of
daily life continuing: children and pets in the background, ringing doorbells and cats walking
in front of the camera. There was also the odd technical difficulty that participants worked
through with support from a Commission staff member. A number of these videos have been
published on the Commission’s website.

Community witnesses reflected on the process of discussing their statements, and how it felt
speaking to Commissioners from their homes, as opposed to the more formal hearings forum:

Thank you again for assisting in bringing my meeting with your Chair, Penny Armytage
to life—it was an incredible opportunity for me that I am still very grateful for … So much
appreciation for what we have created as a team.24

Thanks for giving me this platform and opportunity to share my experiences with
Commissioner McSherry to possibly help others.25

Just a note to say how grateful we are to you for arranging a chat with Professor Fels.
We had a great time and he seemed genuinely interested.26

That meeting with Commissioner Cockram was great!27

I actually preferred to be in my own home. It helped me feel that the power was more
equal. And it was surprisingly comforting to have Angus [the cat] there with me.28

The lists of witnesses who provided statements in 2020 is at Appendix C.

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Miss Denna Healy, witness and spoken word poet, provided a poem as part of her witness
statement. The poem was recorded and the video was published on the Commission’s
website. Following is an excerpt from the poem.

Box 39.10:  Excerpt from a poem written by

community witness Denna Healy29

I see you.
Your mind ruminating about what you could have done differently,
how you could have shown up, who you would rather be ...
You’re in a constant state of disconnect.
With every day flowing into the next.
Anxiety engraved within your being like it’s your middle name.
Mind racing.
Heart thumping; breaking, and growing with every beat.

I hear you.
You cry yourself to sleep most nights, exhausted after long days of
wearing a facade and keeping your truth held close to your chest.
It feels hard to trust.
To open up.
To love.
To risk being hurt yet again.
Vulnerability is a strength disguised as a weakness within
society—opening the door to connection when fully embraced.

I forgive you.
For starving yourself—physically, mentally, emotionally and spiritually.
You weren’t as present as you could have been in life because you didn’t
believe that you had a place in the world.
Your eyes were closed off from the beauty that has always lived within you.

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39.15  Panel hearings

The Commission conducted eight panel hearings that had been scheduled to take place as
part of the Commission’s 2020 public hearings. Panels involved three to four witnesses giving
evidence before Commissioners at the same time. This method allowed Commissioners
to examine a range of areas where there were different views among witnesses. Counsel
Assisting led the questioning. These panel discussions were recorded, and the videos and
transcripts were published on the Commission’s website.

The topics for the panel hearings were:

• community-based mental health

• early intervention in adolescence and youth for good mental health throughout life
• compulsory treatment
• supporting the next generation through good infant and child mental health
• supporting young people and adults living with mental illness who are in contact with
the justice system
• supporting people living with mental illness and alcohol and drug use
• enabling a contributing life
• service configuration.

A list of panel witnesses is at Appendix C.

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39.16  Consumer Foundations

Working Group
In July 2020, the Commission established the Consumer Foundations Working Group which
comprised seven members who together brought a range of skills, expertise, experiences
and perspectives to the Commission’s work. A list of members is provided at Appendix C. The
Commission is grateful for Sarah Jane Haywood’s facilitation of this group.

Working Group members provided advice on reforms related to the leadership of people
with lived experience of mental illness or psychological distress, with a view to creating
an enduring foundation for a future mental health system that is grounded in consumer
expertise. They were invited to consider and provide expert advice on policy proposals.
Members were encouraged to be bold and innovative in their ideas for reform.

The Commission also provided informal opportunities for members to gather and network
online, to ensure they had the space to share ideas, prepare for and debrief after meetings,
and develop their own ideas.

The Commission appreciated the advice, thoughtfulness and generosity of Working Group
members who provided input to the Commission. This input informed the deliberation of
Commissioners who are responsible for the recommendations of the Commission as a whole.
The Commission acknowledges that many members, like many other people with lived
experience of mental illness or psychological distress, have contributed to similar processes
before, sharing their hopes and aspirations to little or no avail. Like the Working Group
members, the Commission hopes this process will be different—that it will lead to a reformed
mental health and wellbeing system that meets the evolving needs and desires of consumers,
and people living with mental illness and psychological distress.

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39.17  Phase 2 of human-centred design

From June to September 2020, the Commission conducted a second and final phase of
human-centred design. During this phase of focus groups, consumers and carers met online
separately and, on a small number of topics, together, to discuss and develop specific reform
ideas that had been identified in the Commission’s work to date. This was an opportunity to
understand the practical implications of potential policy directions and system design from a
range of lived experience perspectives.

A total of 139 consumers and carers with a range of experiences and backgrounds attended
24 virtual focus groups hosted by the Commission, with policy staff in attendance. Topics
covered during the focus groups included core components of the future service model, such
as crisis responses, entry pathways, community integrated mental health services, primary
care, alcohol and other drugs, suicide prevention, bereavement by suicide, perinatal mental
health, housing, bed-based services, information sharing, services for young people, carers of
young people, restrictive practices and compulsory treatment.

In most focus groups, a visual prompt was used to illustrate a range of policy options that had
been raised with the Commission. This tool helped to bring previous contributions into the
room, and supported people with lived experience to share in the analysis of potential policy
directions and provide feedback directly to the Commission’s policy staff.

Focus groups were held online, and most were led by a facilitator with lived experience. The
shift to online engagements, while reducing geographic barriers to participation, did require
participants to use an internet-enabled device. In light of the changed delivery, the format
was adapted. Participants were invited to log into the session to meet the facilitator and
support staff, and settle into the online ‘room’ before the Commission’s policy staff joined.

Many participants positively reflected on their experience participating in the focus groups,
speaking of how they felt heard, and hoped for positive change in the future:

Thank you all for the experience and opportunity to speak of our humanity and solutions
to power over problems ... It was cathartic in terms of seeing that someone sees our
humanity. Thank you.30

Thanks for allowing me the chance to be involved in the focus group. I hope I brought
something valuable to the table/discussion ... Anyway I had a great experience and hope
for some positive change for my local mental health system.31

A graphic recorder captured a visual representation of the conversations using pictures,

words and symbols, so the Commission could confirm with participants that important points
had been understood and documented. The visual canvas and notes taken by Commission
staff were provided to Commissioners. An example is provided at Figure 39.15.

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Figure 39.15:  Canvas capturing a focus group conversation about suicide prevention on 10 July 2020

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39.18  Targeted roundtables

The Commission continued to hold roundtables, this time online, from June to October 2020.
This series of 37 roundtables was designed to help the Commission explore important design
questions. A Commissioner attended every roundtable and most roundtables were chaired by
a Commissioner, with an external facilitator or host leading the other sessions. As with similar
sessions, the discussion was recorded and notes were taken. A list of roundtable attendees is
at Appendix C.

Box 39.11:  Mentally healthy workplaces,

mentally healthy Victoria roundtable

In recognition of the important role that business and workplaces play in

promoting good mental health for their employees, customers and the broader
communities in which they operate, the Commission invited a range of
representatives from the business sector to attend a roundtable.

The mentally healthy workplaces, mentally healthy Victoria roundtable sought

insights from the business sector about:

• where there are opportunities to make use of existing expertise in

addressing mental health in their own organisation or industry
• their reach across the community
• an innovation mindset to support new ways of working and doing business.

This topic was particularly important in the context of COVID-19, which saw
changes to, and in some cases the closure of, various industries.

The roundtable, facilitated by Professor Rod Glover from Monash Sustainable

Development Institute, provided the Commission with an opportunity to learn
from the work that businesses are doing. This information was of interest to the
Commission, as it may support workplaces across Victoria to both fulfil their legal
duties as an employer to provide a safe workplace, and to create an environment
where employees thrive.

The important contribution business makes to the broader community, beyond

the scope of their own staff and workplaces, was also discussed and considered
as an important input for the Commission’s deliberations. The roundtable was
a distinctive event in that it reached beyond mental health services to gather
evidence about responding to and preventing barriers to good mental health.

It was a privilege to join the roundtable and to hear and learn from others.32

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Box 39.12:  Regional roundtables

The COVID-19 restrictions saw the Commission adjust its plans, including
cancelling public hearing days planned for East Gippsland and north-eastern
Victoria, areas that had been significantly affected by the 2019–20 summer
bushfires. The Commission instead held regional roundtables in these areas,
once management of COVID-19 restrictions within those communities had been
well established, and people and organisations were in a position to talk with the
Commission again.

An online roundtable helped the Commission get a better understanding of

the unique perspectives and experiences of services and consumers in East
Gippsland and north-eastern Victoria. The Commission worked with, and was
hosted by, local partners in bringing together a range of services and people
with lived experience. Participants shared their experiences and ideas, and the
Commission considered these in its deliberations.

Each area was unique in what they brought to the roundtable, with
themes such as:

• trauma and bushfire impacts

• experiences of farmers
• isolation and implications for service access
• the needs of Aboriginal and culturally and linguistically diverse
communities
• the realities for service delivery in regional and rural areas.

Case studies and personal experiences were presented to the Commission. For
example the story of a primary-school-aged boy living with family conflict, who
was evacuated from two houses during the fires in early 2020. The school noted
changes in his behaviour, including a decline in his schooling, suicidal ideation,
self-harm, destructive behaviour at school and threats of harm to others. The
school and family both tried to access child and youth mental health services, but
were told there were no services available for him. The child was without mental
health support services until a hospital admission.

Another personal story was from a local farming couple who lost their home and a
large amount of their farming crop in early 2020. They spoke about the realities of
farming life: drought, fire, flood and succession planning.

it was a very, very stressful period like for probably 18 months to two years
having to make phone calls every month on who we can pay and who we
can’t pay and how we’re going to hang on is very difficult and then dealing
with a young family at the same time.33

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These roundtables echoed what the Commission had heard about the differences
between regional and rural living, and what this means for people living with
psychological and emotional distress. A common theme that came up was the
importance of local knowledge and service providers.

It was totally useless; I spent all my time trying to explain to the counsellor/
mental health worker about the farm or why what they were suggesting
wouldn’t work or that the referral they gave me was to a service that is
miles away.34

Our community that we look after is quite diverse and it’s from farming,
small industry, small business professionals, environmental groups and it’s
quite a low socioeconomic area.35

The Commission was grateful for the work of the hosting organisations and
those who gave presentations to the Commission to demonstrate the distinctive
barriers and opportunities in their areas.

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39.19  Workforce survey

The Commission engaged independent consultants to conduct a survey of frontline mental
health workers to gain an understanding of Victoria’s mental health workforce and to hear
their ideas for change. Almost 3,000 people participated in the survey, which was a good
response rate, also noting the increased pressure on the workforce as they responded to the
COVID-19 pandemic and remote working arrangements.

The Commission worked with organisations and unions across the mental health sector to
promote the survey and encourage participation.

Responses were collected across a wide range of professions, roles and workplace settings,
broadly reflecting the diversity of the mental health workforce across Victoria. While
just under 5 per cent of survey responses received were from workers primarily in a lived
experience role, the majority of respondents across diverse professional roles and settings
reported having lived experience of mental illness, or of caring for a friend or family member
living with mental illness. This illustrates the breadth of lived experience in the current mental
health workforce. Many respondents expressed their appreciation of the opportunity to
contribute to the Commission. The workforce survey, as shown in Figure 39.16 was open from
27 July to 12 August 2020.

Figure 39.16:  Future mental health system – workforce survey36

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39.20  Community workshops

The Commission closed its public engagement the same way it commenced: by inviting
the general public to connect and have conversations about mental health and wellbeing.
Two virtual workshops marked the end of the Commission’s formal public engagement in
October 2020.

Local community members in Wangaratta and south eastern metropolitan Melbourne met
with the Commission on 6 and 7 October 2020 respectively in two separate online workshops
to talk about what communities can do at a grassroots level to strengthen wellbeing and
promote good mental health. The workshops were not looking at the mental health system
specifically, but focused on prevention and promotion. Involvement in this conversation,
unlike human-centred design focus groups, was not limited to people with lived experience.
In fact, the invitation was broad to encourage any member of the public with an interest in
prevention and promotion to attend.

Attendees included parents, young people, older people, workers in the health and human
services systems, artists and playwrights, school teachers and principals, faith leaders,
tradespeople and sporting club members. While lived experience of mental illness or
familiarity with the mental health system was not required, participants brought a range of
experiences, some of which included lived experience.

The workshops were interactive and ran for two and a half hours, with participants allocated
to smaller groups to discuss social connectedness and the roles that communities can play
in promoting good mental health and wellbeing. The Commission heard that social isolation
and loneliness in communities are associated with poor mental health and are increasing in
Victoria, particularly among older Victorians.

Conversations in the workshops spanned definitions of good mental health and wellbeing,
promoting good mental wellbeing in day-to-day activities, and opportunities to strengthen
these from a grassroots perspective. People spoke about the importance and the difficulty of
building community connections, as well as supporting wellbeing, particularly where people
are adapting to new environments:

The young kids, especially the young men, really are developing their bonding with
the soccer teams. They love it, they engage with it; I have a client, a kid who’s lost
three to four years in the detention camp now back to school. And he’s thriving in that
environment, connecting, developing bonding with other culture voices from the other
cultures. So I think outdoor activities definitely helped them.37

Commission staff attended to hear from participants directly, help guide discussion and take
notes of the proceedings. A graphic recorder captured the conversation using a variety of
words and pictures as shown in Figure 39.17.

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Figure 39.17:  Canvas recording of the conversation held with members of the south eastern
metropolitan Melbourne community as part of a community workshop on 7 October 2020

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39.21  Final report

The final report marks the close of the Commission’s work. While the interim report set the
foundations, this report contains an ambitious blueprint for transforming Victoria’s mental
health system, and improving the lives of people living with mental illness or psychological
distress, families, carers and supporters, and the Victorian community now and in the future.

All of the information the Commission has received throughout its inquiry has informed the
final report and the Commission’s recommendations.

While policy analysis and research proceeded across the Commission’s inquiry, the core
writing for the final report took place from October to December 2020, after the Commission
closed its public engagements at the beginning of October 2020.

The final report is accompanied by a summary and recommendations, Plain Language and
Easy Read outlines, and a short animated video.

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39.22  Acknowledgements
The Commission would like to thank all those who made contributions to this inquiry—people
with lived experience, members of the workforce, academics, government officials and those
in related fields—for sharing their time, perspectives and ideas. The fact that engagement
with the Commission continued at pace during the COVID-19 pandemic was a testament to
the considerable interest and dedication of so many in the Victorian community to building
a better mental health and wellbeing system. The Commission is particularly grateful for
the many contributions from people with lived experience, and recognises that these
contributions were often deeply personal and sometimes difficult for people to share.

The Commission acknowledges that many people shared personal, sometimes tragic
experiences in the generous hope of improving treatment, care and support for others:

It is my hope that by sharing some of my experiences, I can help be part of the process of
change, so that no other child or adolescent has to go through what I went through in an
attempt to recover from a mental illness.38

The Commission was supported by strong connections with key lived experience peak bodies,
VMIAC and Tandem, and also by VACCHO. The Commission acknowledges the support of
these organisations and thanks them for the commitment they showed to the Commission’s
work, and for supporting a wide range of people with lived experience to engage with the
Commission.

The Commission would like to acknowledge several people who assisted the Commission with
its policy work and processes, often over many months: Chris Kotur; Gemma Varley; Shane
Solomon; Professor Hal Swerissen; Professor Rod Glover; James Mansell; Gareth Edwards;
Dr Nina Terrey; Max Harman; Simon Katterl; Cathy Balding and Lesley Thornton. While all
of the work in this final report is that of the Commission, these individuals supported legal,
engagement and policy processes.

The Commission appreciated engagement with the Productivity Commission during

the course of its inquiry into mental health, including with its Commissioners and staff.
In addition, the Commission is grateful for the time given by Christine Morgan, CEO of
the National Mental Health Commission and National Suicide Prevention Adviser to the
Prime Minister, and the Department of the Prime Minister and Cabinet as well as the
Commonwealth Department of Health, in progressing conversations about mental health and
system design. These connections provided the Commission with a deeper understanding
of issues and opportunities from a national perspective, including opportunities for
collaboration and partnership.

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1 The Honourable Daniel Andrews MP, Premier of Victoria, Media Release: Experts to Lead the Mental Health Royal
Commission, 24 February 2019, <www.premier.vic.gov.au/experts-lead-mental-health-royal-commission>, [accessed
1 September 2020].
2 Victorian Government, Royal Commission into Victoria’s Mental Health System—Letters Patent, 2019, para. IV(i).
3 Victorian Government, Royal Commission into Victoria’s Mental Health System—Letters Patent, para. I(4).
4 The Honourable Daniel Andrews MP, Premier of Victoria, Media Release: More Time to Design a Better Mental
Health System for Victoria, 27 May 2020, <hnb.dhs.vic.gov.au/web/pubaff/medrel.nsf/AllDocs/ABA0B5C3D6194D
D5CA2585750006C1BB/$FILE/200527-More-Time-To-Design-A-Better-Mental-Health-System-For-Victoria.pdf>,
[accessed 7 January 2021].
5 Victorian Government, Royal Commission into Victoria’s Mental Health System—Letters Patent, para. III(a).
6 Victorian Government, Royal Commission into Victoria’s Mental Health System—Letters Patent, para. IV(f).
7 Royal Commission into Victoria’s Mental Health System, Interim Report, 2019, p. 5.
8 Witness Statement of Janet Meagher AM, 1 July 2019, para. 35.
9 Victorian Government, Royal Commission into Victoria’s Mental Health System—Letters Patent, para. III.
10 RCVMHS, Seymour Community Consultation—May 2019.
11 RCVMHS, Media Release: Have Your Say to Improve Victoria’s Mental Health System, 17 April 2019, <rcvmhs.vic.gov.
au/news/have-your-say-improve-victorias-mental-health-system>, [accessed 28 October 2020].
12 Anonymous 107, Submission to the RCVMHS: SUB.0002.0032.0056, 2019, pp. 3 and 9.
13 Correspondence from ‘Susan Trotter’ (pseudonym), July 2019.
14 Correspondence from Anonymous, April 2020.
15 RCVMHS, Interview with Julie Rickard, August 2020.
16 Witness Statement of Aunty Nellie Flagg, 9 July 2019, para. 35.
17 Department of Health and Human Services, Balit Murrup: Aboriginal Social and Emotional Wellbeing Framework
2017–2027, 2017, p. 50.
18 Victorian Aboriginal Community Controlled Health Organisation, Correspondence to the RCVMHS:
CSP.0001.0114.0001. Balit Durn Durn Report, 2020, p. 10.
19 Mike Cooley, Chapter 4: Human Centred Design, in Information Design (Massachusetts Institute of Technology: MIT
Press, 1999), pp. 59–82 (p. 64).
20 RCVMHS, Youth Female Criminal Justice Human-Centred Design Focus Group: Record of Proceedings, 2020.
21 RCVMHS, Adult Female Criminal Justice Human-Centred Design Focus Group: Record of Proceedings, 2020.
22 Correspondence from a Human-Centred Design Participant, August 2020.
23 RCVMHS, Workforce Focus Group: Record of Proceedings, 2020.
24 Correspondence from Denna Healy, August 2020.
25 Correspondence from ‘Nathan Turner’ (pseudonym), November 2020.
26 Correspondence from ‘Mary and Jacob Corbett’ (pseudonyms), August 2020.
27 Correspondence from Kiba Reeves, September 2020.
28 ABC News, How Angus the Cat Helped a Mental Health Royal Commission Witness Feel More Equal
Giving Her Testimony, 27 May 2020, <www.abc.net.au/news/2020-05-27/mental-health-royal-commission-
coronavirus/12288698>, [accessed 5 November 2020].
29 Correspondence to the RCVMHS—Poem of Denna Healy: CSP.0001.0123.0001, 2020.
30 Correspondence from a Human-Centred Design Participant, September 2020.
31 Correspondence from a Human-Centred Design Participant, July 2020.
32 Correspondence from a Roundtable Participant, September 2020.
33 RCVMHS, East Gippsland Roundtable: Record of Proceedings, 2020.
34 RCVMHS, North Eastern Victoria Roundtable: Record of Proceedings, 2020.
35 RCVMHS, East Gippsland Roundtable: Record of Proceedings.
36 ORIMA Research, Mental Health Workforce Survey, 2020.
37 RCVMHS, Southern Metro Community Workshop (Dandenong / Frankston): Record of Proceedings, 2020.
38 Anonymous 60, Submission to the RCVMHS: SUB.0002.0022.0023, 2019, p. 1.
39 Listening to Voices Theatre Group, Submission to the RCVMHS: SUB.0002.0032.0032, 2019, pp. 21–22

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Chapter 40

The operations
of the Commission 

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40.1  Commission operations

The Commission began operating in February 2019. It occupied a small separate space and
used some information technology (IT) equipment and systems at the Department of Premier
and Cabinet’s office.

The initially small Commission team reviewed previous royal commission reports and spoke
to government contacts who had set up similar operations, and came up with a set of
priorities that comprised:

• developing the budget needed to support the Commission

• recruiting the staff and contractors required to do the Commission’s work
• acquiring and moving into an independent office
• establishing and operating a separate, protected IT environment.

The team then set up processes to ensure the Commission could operate effectively,
independent of government, including:

• governance, decision-making and risk-management processes

• planning and project-management functions
• financial management and delegations
• procurement and contract-management processes
• people and culture policies and processes
• records-management protocols.

Where possible, the team sought support from other entities, including from:

• the Department of Premier and Cabinet—for initial accommodation, IT and advertising

for staff and recruitment
• the Shared Service Provider within the Department of Treasury and Finance—for
finding suitable long-term accommodation
• a range of Victorian public service departments and agencies—these entities allowed
some of their people with much-needed capability to join the Commission’s staff on
short notice.

The team used established operational processes wherever possible. For example, they used
State Purchase Contracts to secure providers quickly and on standard government-approved
terms to achieve value for money.

The Commission was able to set up its operations quickly using a combination of these
processes and support.

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40.2  Governance and decision making

In setting up its operations, the Commission considered how it would be organised and how
decisions would be made. A structure was developed with functions that comprised:

• Commissioners—the Chairperson had overall accountability for the Commission’s

activities—such as overseeing its program of work, inquiries, engagement, reports and
recommendations—to meet the terms of reference. A Commissioners’ Charter set out
the respective responsibilities of the Chairperson and Commissioners. Commissioners
shared strategic oversight of key activities, whereas the Chairperson was responsible
for the Commission’s operations.
• Staff of the Commission—led by the CEO and supported by the Executive Leadership
Group, the staff of the Commission were organised into four branches:

– Policy and Research—teams of policy and research experts with primary

responsibility for managing and analysing data, evidence and other information
the Commission obtained; developing work packages and policy directions for
Commissioner consideration; and writing and producing the Commission’s reports
– Community Engagement—teams that managed the Commission’s programs of
engagement with stakeholders; provided support to the public in their contact
with the Commission; and ran the Commission’s media relations, and internal and
external communications activities
– Advisers and Executive Support—a small team that supported and advised the CEO
and Commissioners
– Corporate Services—a team that managed services for the Commission, including
finance and procurement, people and culture, IT and records management, legal,
governance, risk management and accommodation.

• Counsel Assisting—facilitated the inquiry by advising on the Commission’s powers,

duties, functions and obligations; conducting hearings; supporting report writing and
the presentation of evidence; and helping to manage and administer inquiry processes
and procedures.
• Solicitors Assisting—a contracted legal services firm, Herbert Smith Freehills, was
appointed to provide legal advice as the Commission’s solicitors; support Counsel
Assisting and the hearings process; work with parties’ legal representatives; and help
manage evidence.
• Expert Advisory Committee—an eight-member expert committee was established as
requested by the letters patent, to advise the Commission on all matters it considered
appropriate during the inquiry. Members had a wealth of knowledge in lived experience
and professional and sector experience with Victoria’s mental health system.

Figure 40.1 shows the structure of the Commission.

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Figure 40.1:  Commission structure

The Commission implemented a governance framework to support this structure, oversee the
delivery of its work and guide decision making. This comprised:

• Commissioners’ meetings—formal meetings of the Chairperson and Commissioners

were held and attended by the CEO and staff. These meetings were the main forum for
considering the Commission’s work.
• Expert Advisory Committee meetings—during formal committee meetings, the
Commission and the committee discussed and tested the Commission’s work.
• Executive Leadership Group meetings—formal meetings of the Leadership Group
discussed important issues and risks associated with the Commission’s work program
and operations.

Figure 40.2 shows the Commission’s governance.

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Figure 40.2:  Commission governance

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40.3  Practice directions and protocols

Under the Inquiries Act 2014 (Vic) a Royal Commission may issue practice directions.1

The Commission made two practice directions. Practice direction number 1 related to the
conduct of the Commission’s public hearings.2 Practice direction number 2 related to the
production of material and document management protocol for providing information under
a Notice to Produce to the Commission.3

The Commission also entered into a protocol with the State of Victoria to set out the process
of timely access to documents and data.4 The protocol established a mechanism for dealing
with claims of public interest immunity made over documents produced by the State.5 This
protocol was read in conjunction with practice direction number 2.

40.4  Notices to produce

The Inquiries Act provides a royal commission with the power to compel the production of
documents to a royal commission.6 This power allows a royal commission to gather a strong
and broad evidence base to underpin its work and receive information that is not ordinarily
publicly available.

The Commission issued 217 Notices to Produce (Table 40.1). Documents and data produced to
the Commission had to comply with the Document Management Protocol set out in Practice
direction number 2.

The Commission received 8,243 documents through the Notice to Produce process. Some
documents provided by agencies were subject to the following claims:

• public interest immunity

• personal information
• legal professional privilege
• statutory secrecy or statutory confidentiality.

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Table 40.1:  Notices to Produce issued by the Commission

Agency Number Number of

of NTPs documents produced
Albury Wodonga Health 1 12
Alfred Health 2 38
Ambulance Victoria 3 25
Austin Health 2 13
Ballarat Health Services 1 9
Barwon Health 2 86
Bendigo Health 2 48
Department of Education and Training 8 100
Department of Environment, Water, Land and Planning 1 4
Department of Health and Human Services 110 4,987
Department of Jobs, Precincts and Regions 6 41
Department of Justice and Community Safety 16 1,504
Department of Premier and Cabinet 11 137
Department of Treasury and Finance 5 120
Doveton College 1 1
Eastern Health 3 13
Emergency Services Telecommunication Authority 2 18
Goulburn Valley Health 1 1
Kalinda Primary School 1 1
Latrobe Regional Hospital 2 18
Melbourne Health 5 233
Mental Health Complaints Commission 3 50
Mental Health Reform Victoria 1 1
Mental Health Tribunal 1 20
Mercy Health 1 17
Monash Health 2 2
Northern Health 1 1
Peninsula Health 1 69
Southwest Healthcare 2 45
St Vincent's Hospital Melbourne 1 48
The Royal Children's Hospital 2 32
Victoria Police 7 88
Victoria Workcover Authority 4 204
Victorian Institute of Forensic Mental Health 4 247
Victorian Public Sector Commission 1 4
Western Health 1 9
Total 217 8,246

Note: Includes Notices to Produce issued for the production of witness statements. The number of documents
produced is an approximate number due the reproduction of some documents.

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40.5  Finance and procurement

The Victorian Government allocated $37.1 million to cover the Commission’s operations, over
three financial years from 2018-19 to 2020–21. This includes funds to extend the Commission’s
final report deadline from 31 October 2020 to 5 February 2021.

The Commission’s estimated total expenditure is $35.7 million. This estimate of all costs
associated with the Commission reflects actual costs incurred to 31 December 2020 as well as
an estimate of costs for the final period of operation from 1 January to 5 February 2021 and
expected wind-down and decommissioning costs to 31 March 2021.

Costs incurred by the Commission for the period 22 February 2019 to 30 June 2020 were
included in the audit by the Victorian Auditor-General’s Office as part of its annual financial
audits of the Department of Premier and Cabinet, which processed all Commission expenses.
The costs incurred for the period 1 July 2020 to 31 March 2021 will be included in the audit by
the Victorian Auditor-General’s Office as part of its annual financial audit of the Department
of Premier and Cabinet at the end of the 2020–21 financial year.

40.5.1  Internal controls

The Commission was committed to providing value for money and good financial governance
when spending public funds. Accordingly, it was careful to ensure it had internal controls in
place for its financial management.

Corporate Services coordinated the Commission’s funding requirements and financial

management in conjunction with the CEO and Chairperson of the Commission.

Although the Commission managed its own financial decisions and processes, the
Department of Premier and Cabinet’s finance team supported the Commission with reporting
and accounts payable.

Using the powers conferred in the letters patent and in accordance with the Inquiries Act,
the Chairperson issued delegations to several executive staff to support the Commission’s
effective operation.7 This permitted directors to approve expenditure up to $25,000 and
the CEO to approve up to $150,000. The Chairperson authorised expenditure above those
delegations.

The Commission also used the internal controls built into the finance system, such as
position-controlled delegations, as well as segregation of duties for approving payments.

Corporate Services provided staff with advice and support to ensure they had the knowledge
and expertise to follow policies and processes regarding Commission expenditure.

The lead of Finance and Procurement and the director of Corporate Services undertook
regular reviews of financial transactions and ensured there was correct documentation to
support financial decisions.

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40.5.2  Financial management

As noted above, a budget was constructed early in the Commission’s establishment.

The budget was divided into cost categories, and these formed the basis for the
Commission’s financial reporting framework, which assisted the Commission to plan and
manage its expenditure.

Each month, the Corporate Services director and Finance and Procurement lead worked
together to create a financial reporting package. The package was approved by the CEO and
was distributed to and discussed with the Executive Leadership Group. High-level financial
reporting was also provided monthly to the Commissioners as part of their meetings, so the
Commission was aware of how the budget was tracking overall.

In addition to this reporting, Corporate Services, as well as the cost category and contract
managers, were in regular contact so they could identify any financial risks and issues early.

As the Commission progressed, Corporate Services undertook several budget reviews to

realign the budget with the Commission’s shifting priorities and needs.

The onset of the COVID-19 pandemic was one major example of this. As outlined in
Chapter 39: The work of the Commission, the pandemic resulted in the cancellation of in-
person activities, such as hearings, which reduced expenditure in this area. However, it led
to an increase in other expenditure because resources needed to be reallocated to collect
evidence and interact virtually with interested parties. Corporate Services worked closely
with the Executive Leadership Group and the Commission to provide visibility over the
Commission’s finances and to support these decisions.

40.5.3  Procurement
The Commission adopted standard policies and processes in line with Victorian public sector
guidelines to manage procurement. Consistent with Victorian public service procurement
practice, the Commission at times applied exemptions whilst maintaining competitive
procurement processes. The procurement processes included:

• testing the market based on the value of the proposed procurement

• signing off and appropriately delegating and managing conflicts of interest for all
involved in the procurement processes
• recording assessments of value for money
• using State Purchasing Contracts.

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40.6  Information technology, records

management and data management
Given the volume and sensitivity of the information the Commission received, great
importance was placed on ensuring this information was efficiently managed and kept safe.
This meant implementing an independent protected-level IT system and a strong approach
to records and data management.

Corporate Services was responsible for designing and managing the Commission’s IT
environment, supported by a partnership of managed services providers Citadel (Kapish) and
SXIQ. The Commission engaged these providers within the first few months of its operations
from a select tender process using the Victorian Government eServices register for IT services.

This team was supported by electronic document and evidence management services from
three sources—the Commission’s Solicitors Assisting firm, an independent IT security firm
(Trusted Impact) and a team in the Policy and Research Branch dedicated to managing
Commission data.

40.6.1  Information technology

The Commission’s IT environment needed to comply with Australian Cyber Security Centre
guidelines and Victorian Protective Data Security Framework controls to a ‘protected level’ in
order to maintain a high level of security for the Commission’s information and data.

Other requirements included a standard operating environment and intuitive software

applications so the system could be set up quickly and easily used by Commission staff. It
also needed to be adaptable over the life of the Commission to ensure information flowed
smoothly and the Commission’s engagement activities were supported.

The ability to have good information flow and the need to support virtual engagement
activities became more important as the COVID-19 pandemic resulted in staff working
remotely and the Commission’s engagement activities moving to an online format rather
than face-to-face. The Commission quickly mobilised to use collaboration software such
as Zoom and Microsoft Teams, which enabled staff to conduct activities online. Staff and
contractors were provided with portable devices to help them work flexibly, and Commission
contractors provided desktop support via an onsite technician and an after-hours number in
peak periods. IT help guides were also developed so staff could resolve issues independently
where possible.

The Commission placed great emphasis on regular maintenance, backup and security of
systems and devices to protect information and the Commission’s work. Staff were given
information security training and the environment was managed in accordance with a
range of policies, procedures and protocols. This included monthly service delivery meetings
between Commission staff and its managed service providers, as well as regular IT risk
assessment meetings and security testing.

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40.6.2  Records management

The Commission’s electronic document records management system was first set up on
the Content Manager platform, but moved to the Microsoft SharePoint platform as part of
its standard operating environment for its working documents. The Commission needed
the usability and flexibility of SharePoint, including the ability for multiple users to work on
documents together in real time. While this was a new platform for many staff, SharePoint
provided much-needed efficiency. Staff adapted to the platform and it proved to be vital
in producing the final report, which staff largely wrote working from home due to COVID-19
restrictions.

The Commission chose the NVivo platform to host its source documentation and reference
materials. This database became the main repository for research materials, submissions,
hearings materials such as transcripts and exhibits, correspondence, responses to Notices to
Produce, and formal records of engagement activities.

The NVivo platform also allowed staff to sort, search, code and extract information, helping them
to analyse the suite of information, to inform findings and write reports and recommendations.

As mentioned above, the Commission was supported by the document management arm of
its Solicitors Assisting firm. The firm processed, catalogued and stamped formal evidence
and then provided it to the Commission to upload into NVivo.

While the Commission valued flexibility and usability in its records management approach,
it was mindful that documentation would ultimately become part of the public record.
Accordingly, the Commission worked with the Department of Premier and Cabinet and Public
Record Office Victoria to set up a records management framework that would comply with
the archive requirements in the Inquiries Act and the Retention and Disposal Authority under
the Public Records Act 1973 (Vic). 8

40.6.3  Data management

The Commission established an in-house data analytics team to manage the data it
received. The team helped ensure the data was used effectively and that the Commission’s
findings and recommendations were evidence-informed.

The Commission sought and received datasets from a range of Victorian Government
departments, agencies and funded services including:

• Ambulance Victoria
• Coroners Court of Victoria
• Department of Education and Training
• Department of Health and Human Services
• Department of Justice and Community Safety
• Emergency Services Telecommunications Authority
• Mental Health Complaints Commissioner
• Mental Health Tribunal
• Victoria Police

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• Victorian public health services and public hospitals

• WorkSafe Victoria.

The Commission also received the Victorian Social Investment Integrated Data Resource,
which is an enduring linked data resource combining information on Victorian health care,
community care, education, crime and safety. The dataset enabled the Commission to not
only investigate a population at a specific time (cross-sectional data) but also changes over
time (longitudinal data). Longitudinal data provides valuable insights over an individual’s life
course—insights that are not usually available in standalone datasets.

The Commission is grateful to these departments and agencies for providing these datasets
and supporting the Commission to use and analyse their content appropriately.

The Commission also created a merged dataset that included the:

• Victorian Admitted Episodes Dataset

• Victorian Emergency Minimum Dataset
• Victorian Client Management Information and Operational Data Store
• Commonwealth Government’s Medicare Benefits Schedule
• Commonwealth Government’s Pharmaceutical Benefits Scheme.

The merged dataset helped the Commission to understand, at a de-identified individual level,
the use of relevant services. Ethics approval was obtained from the Australian Institute of
Health and Welfare to integrate these datasets, and the merged data was accessed through
The Sax Institute.

The Commission is grateful to the Commonwealth Department of Health for providing

the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data. In using
these datasets, the Commission ensured it always complied with relevant legislation and
regulations, including the Health Records Act 2001 (Vic), Mental Health Act 2014 (Vic) and
Privacy and Data Protection Act 2014 (Vic).

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40.7  People and culture

A royal commission is an unusual place to work. There are many moving parts and tight
deadlines, and staff need to be flexible, solution-focused and hardworking. The Commission’s
people were a crucial element of its operations.

Many of the Commission’s staff joined the Commission because they were motivated to make
a difference and to contribute to real and lasting change in Victoria’s mental health system.
They were extremely dedicated to the Commission’s purpose and worked very hard as a result.

Considering the challenging environment, the Executive Leadership Group and

managers focused on providing strong people-support services and driving a positive
organisational culture.

Corporate Services provided people and culture services, with support from the Department
of Education and Training’s HR Shared Services function for its payroll.

40.7.1  Workforce
The people working at the Commission came from a variety of backgrounds, including the
Victorian public sector, the health sector, non-government organisations and the private sector.

The Commission was deliberate in recruiting staff with diverse backgrounds to provide
breadth in experience and perspective, and depth in its capability. The Commission reached
out to relevant organisations to promote job advertisements in order to encourage people
with lived experience to apply. It also advertised for roles through standard channels such
as the Careers.Vic website and the Jobs and Skills Exchange, an internal web portal set up to
find talent within the Victorian public service.

The Commission engaged its staff under various arrangements including secondment and
fixed-term appointments. Where necessary, some staff were also directly employed on contract.

Due to the variability of the Commission’s work, and the need to build operations quickly and
to wind down quickly, staff numbers fluctuated greatly. A core contingent of about 45 staff
were present for most of the Commission’s timeline.

40.7.2  Culture
One challenge of a royal commission is quickly bringing together a range of people, many of
whom have not worked together before, to work in a pressured environment to solve complex
problems within tight deadlines.

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Recognising this challenge, and as fitting for a royal commission into mental health, the
Executive Leadership Group prioritised initiatives to foster a collaborative, supportive and
innovative culture. They wanted to build high-performing teams in which everyone supported
each other, shared ideas and worked together towards a common goal. This included being
willing to share the workload, take on additional responsibilities and do what was needed to
deliver on the Commission’s objectives.

Despite staff having specific roles and responsibilities, there was always the understanding
that everyone was working together for the same purpose and outcome. There was support
from different teams and across functions to ensure work was produced efficiently and
delivered on time.

The Commission prioritised a range of cultural initiatives including workshops focusing on

team values and behaviours, social activities, opportunities to share and tell stories, and
flexible work arrangements.

The Commission was dedicated to continuous improvement and regularly reviewed

processes and implemented what was learned.

Two important aspects of the Commission’s culture were wellbeing and staff learning and
development. These are outlined further below.

40.7.3  Wellbeing
The Executive Leadership Group recognised that staff could be affected by the Commission’s
high-pressure environment and its sensitive and critical subject matter. Commission
staff were often exposed to accounts of traumatic events and various other confronting
information. To mitigate any negative impact on staff, the Commission established a
Wellbeing Framework to support its people to care for their own and each other’s mental
health and wellbeing. This framework was developed collectively by staff and was supported
and maintained by Corporate Services. It covered four pillars: mind, body, connection
and purpose.

Staff were encouraged to integrate mindfulness into their work and to be aware of their
colleagues’ mental health. To support this, the Commission engaged Carfi Psychological and
Rehabilitation Services, and Carfi became embedded in Commission operations. Staff could
contact Carfi confidentially at any time or have one-on-one sessions with them.

Carfi checked on staff welfare by walking the office floor and chatting with them. They also
facilitated debriefs after challenging milestones such as community consultations and
hearings, and ran group support sessions. During the COVID-19 restrictions, for example, they
ran sessions for staff who had to balance their work with caring responsibilities.

The Executive Leadership Group encouraged staff to maintain work-life balance and to eat
well, move regularly and look after their physical wellbeing more generally.

The Executive Leadership Group focused on creating opportunities for people to connect and
share—for example, by celebrating milestones and important days. There were also informal
ways staff continued to connect with each other such as weekly staff stand-up meetings
hosted by the CEO and regular staff gatherings.

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While the Executive Leadership Group initiated many activities, they were supported by the
Commission’s Health and Safety Committee. The director of Corporate Services chaired
the committee, which included people with specific health and safety roles such as first aid
officers, wardens and health and safety representatives. The committee met many times to
consider staff health and safety, and ways it could be improved.

A committee was also formed to lead the Commission’s health and safety response to the
COVID-19 pandemic, overseeing:

• implementation of related policies and procedures such as the Commission’s

COVIDSafe Plan
• more frequent cleaning of the office
• support for staff to work effectively from home during lockdown
• management of the recovery after restrictions were eased.

Commissioners also actively supported staff health, safety and wellbeing, and the CEO and
the Leadership Group provided regular reports to them about human resources and culture.

40.7.4  Learning and development

While many staff said they joined the Commission primarily out of a desire to contribute
to lasting change in the Victorian mental health system, they also joined to learn and grow
professionally and personally. In response to this, the Leadership Group and managers
worked with staff to agree on development plans that comprised work, self and team goals.
These plans aligned with Victorian public sector development and progression frameworks.

The Commission provided staff with opportunities for formal learning, particularly to help
them understand aspects of the mental health system. This comprised cultural awareness
training and workshops on lived experience run by people with lived experience. The
Commission ensured as many staff as possible were provided with this training before
attending consultations and hearings.

Carfi ran several information sessions to educate and inform staff on how to best manage the
challenges that lay ahead during their time at the Commission.

Training and briefing sessions were held about operational matters such as the Commission’s
responsibilities under the Inquiries Act, IT security, privacy and information management,
and hearings operations.

40.7.5  Transition support services

In recognition of the contributions staff made to the Commission and to further support their
personal and professional growth, the Commission provided transition support services to
help staff move to their next work venture. This included a series of workshops for staff on
career growth mindset, career planning, the job market, résumé and job application writing,
and interview skills.

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40.8  Office accommodation

As there was little vacancy in government-owned accommodation when the Commission
was established in February 2019, it occupied a small office space made available by the
Department of Premier and Cabinet. Assisted by the Department of Treasury and Finance’s
Shared Service Provider, the Commission found a floor to lease at 271 Collins Street in
Melbourne’s central business district.

The office location was close to public transport options, and the building had bike storage
facilities and showers for staff who wanted to ride, walk or run to and from work. The office
was already suitably fitted out and mostly furnished, which helped staff move in quickly and
kept accommodation costs down.

In March 2020, when the COVID-19 pandemic worsened, the Commission transitioned staff
to work from home. When staff were still working in the office, the Commission ensured
appropriate cleaning, hygiene and safety processes were in place, and that staff and visitors
followed the Commission’s COVIDSafe Plan.

40.9  Risk management, business

continuity and security
The Commission put assurance frameworks and activities in place to manage risks and
ensure business continuity and the security of its staff, stakeholders, assets and office.

40.9.1  Risk management

Risk management was crucial to ensuring the Commission successfully managed and
delivered its work.

The Commission built on existing Victorian Government risk management guidance and
implemented its own risk management framework. It developed and implemented a strategic
risk register and operational risk registers for important areas such as IT. These were used to
outline, measure and assess the likelihood and impact of adverse events, and ways of dealing
with them.

Risk management processes and documentation were also implemented for deliverables
such as the interim and final report, and for major community engagement activities such
as community consultations and forums, hearings and workshops. This ensured coverage for
risks in delivering these highly complex products and activities.

The risk registers were regularly updated and discussed at Executive Leadership Group
meetings to ensure there was a holistic view of the Commission’s risks and how they were
being addressed.

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The risk framework was managed by Corporate Services and overseen by the Commission’s
Executive Leadership Group. The Commission also received monthly reports on strategic
risks and engaged with the Executive Leadership Group and staff to manage risk.

40.9.2  Business continuity

The Commission implemented business continuity planning as part of its risk management
framework. This was particularly critical in IT, given the Commission’s reliance on the IT
environment in delivering its reports. The Commission successfully enacted parts of its plan
when the COVID-19 pandemic struck and staff started working from home.

40.9.3  Security
Security was a priority for the Commission. Security considerations were important in all
aspects, particularly IT and physical security.

As mentioned above, special care was taken in establishing and maintaining the IT
environment and protecting the sensitive information the Commission held.

Physical security was considered in relation to the Commission’s office environment. For
example, the Commission’s office was not publicly accessible, with all staff and any invited
visitors needing to use a swipe card to gain entry.

Physical security was also provided at public-facing events such as hearings. In considering
the level and types of security services it engaged, the Commission was careful to strike
the right balance between protecting staff, contractors and the public while creating a
welcoming atmosphere.

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40.10  Concluding operations

In anticipation of the processes required to conclude the Commission’s operations,
Corporate Services began the planning phase as early as possible. The main considerations
in closing the Commission’s operations were transitioning of staff, transferring records,
decommissioning the IT environment, disposing of assets and vacating the office space.

40.10.1  Staff
As described above, the Commission provided staff with transition support services to help
them move to their next venture. Staff began finishing up with the Commission in October
2020, gradually dispersing until February 2021 when only a few staff remained to wrap up
operations.

40.10.2  Records
The Commission’s substantial inquiries will become an important part of the history and
public record of Victoria. The Commission wanted its records to be useful to subsequent Royal
Commissions or boards of inquiry, and to provide insight into how the Commission operated.

As noted above, the Commission worked with the Department of Premier and Cabinet and
Public Record Office Victoria to transfer Commission records to the Department of Premier and
Cabinet and then to Public Record Office Victoria, in accordance with the relevant legislation.

This ensures that documents relating to the Commission’s inquiries are considered
permanent records. It means that they will be held for the public record at Public Record
Office Victoria for a designated period. Temporary records, such as those about the operation
of the Commission, were transferred to the Department of Premier and Cabinet or destroyed.

The Commission also took care to apply caveats to certain classes of records to ensure
privacy and other interests were protected, consistent with relevant requirements.

40.10.3  IT environment, assets and accommodation

A major part of the Commission’s winding up was sanitising and disposing of IT assets. The
Commission invested in high-quality IT equipment to ensure it could function effectively, and
it was important that any assets that were still working well were returned to the government
for continued use. The Commission’s managed service providers helped ensure the IT
environment was properly decommissioned before assets were passed on.

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1 Inquiries Act 2014 (Vic), sec. 16.

2 RCVMHS, Practice Direction No. 1—Public Hearings: Released 24 May 2019, 2019.
3 RCVMHS, Practice Direction No. 2—Production of Materials and Document Management Protocol: Released 5 June
2019, 2019.
4 Victorian Government, Protocol Between the Royal Commission into Victoria’s Mental Health System and the
Crown in Right of the State of Victoria, 2019.
5 Victorian Government, Protocol Between the Royal Commission into Victoria’s Mental Health System and the
Crown in Right of the State of Victoria, 2019.
6 Inquiries Act 2014 (Vic), sec. 17.
7 Inquiries Act 2014 (Vic), sec. 9.
8 Public Records Act 1973 (Vic), sec. 12.

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Appendices

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Appendix A.1: Letters patent

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Appendix A.2: Amended letters patent

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Appendix B: Data quality statement

B.1 Quality assurance

The data contained in this report was largely prepared by Commission staff. The data was
reviewed by the relevant data custodians for accuracy, where relevant, and validation,
where possible.

The Commission is grateful for the support provided by data custodians. The Commission
also acknowledges the contribution of Department of Health and Human Services, Australian
Institute of Health and Welfare and Queensland Centre for Mental Health Research, University
of Queensland, for advice and support on the Commission’s analysis.

The Commission has endeavoured to use the most accurate, up-to-date and recent data
and information available to inform this report, drawn from a range of data sources that are
referenced throughout.

B.2 Definition of mental illness

The Commission has used the definition of ‘mental illness’ as found in section 4 of the
Mental Health Act 2014 (Vic), being ‘a medical condition that is characterised by a significant
disturbance of thought, mood, perception or memory’.

The Commission has used the mental and behavioural disorders categorised in Chapter 5
of the International statistical classification of diseases and related health problems, Tenth
revision, Australian modification in its analysis of data.

When undertaking analysis of external sources such as the Australian Institute of Health and
Welfare and the Australian Bureau of Statistics, the definition of mental illness in the original
data source has been retained and noted in the relevant section of the report.

Mental health-related presentations from the Victorian Emergency Minimum Dataset were
identified based on if the presentation either:

• resulted in an admission to a mental health bed (inpatient or residential)

• received a mental health-related diagnosis (‘F’ codes, or some selected ‘R’ and ‘Z’
codes (R410, R418, R443, R455, R4581, Z046, Z590, Z609, Z630, Z658, Z765)
• was defined to be ‘intentional self-harm’
• involved an interaction with a mental health practitioner.

This definition may depart from the public reporting approach used by the Department of
Health and Human Services and the Victorian Agency for Health Information.

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B.3 Sources
Most of the data sources are Victorian collections managed by Victorian Government
departments or agencies.

The key data sources used in this report are the:

• Department of Health and Human Services, Victorian Integrated Data Resource v1812
• Department of Health and Human Services, Victorian Integrated Data Resource v1906
• Department of Health and Human Services, Client Management Interface/Operational
Data Store (extracted 1 October 2020)
• Department of Health and Human Services, Victorian Emergency Minimum Dataset
2019–20 (extracted 8 October 2020)
• Department of Health and Human Services, Victorian Admitted Episodes Dataset
2019–20 (extracted 8 October 2020)

These data sources are supplemented by other data collections, such as the Australian
Institute of Health and Welfare and Australian Bureau of Statistics.

Where relevant, the Commission has identified limitations of the relevant data in footnotes
alongside figures.

For some data, the most recently available information is 2014–15 or even earlier. This is
because some data (for example, population-based surveys) is only collected periodically. As
stated above, the Commission has used the most recently available data where possible.

B.4 Presentation
In this report:

• values reported (for example, in the columns and rows of tables) may not sum to the
totals shown, due to missing and not stated values or rounding
• percentages reported may not sum to 100 due to rounding
• percentages reported exclude missing and not stated values, unless otherwise stated
• totals reported include missing and not stated values, unless otherwise stated
• some data may not have been included to avoid identifying individuals or where
estimates are based on small numbers, resulting in low reliability. Information that
results in attribute disclosure has not been included, unless agreement was obtained
from the custodian to publish the data.

B.5 Subject to revision

This report draws data from a range of data sets, which the Commission understands may be
subject to change. For example, such changes may arise from the nature and timing of the
data collection, or from program updates or maintenance. This may result in discrepancies
between the data contained in this report and any published data.

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B.6 Population rates

Crude rates were calculated using either one of two methods (unless stated otherwise):

• Historical data—the Australian Bureau of Statistics estimated resident population

(ERP) at the midpoint of the data range. For example, if the data related to a calendar
year, rates were calculated using the ERP at 30 June or, if the data related to a financial
year, rates were calculated using the ERP at 30 June.
• Future estimates—the Department of Environment, Land, Water and Planning, Victoria
in Future 2019. For example, bed rates for 2019–20 were calculated using the Victoria in
Future estimated population at 30 June 2020.

B.7 Annual rates of change

Annual rates of change or growth rates have been calculated as geometric rates:

Compound annual growth rate = ((Pn/Po)^(1/n) –1) x 100

where Pn = value in later time period

Po = value in earlier time period

n = number of years between the two time periods.

Where the compound annual growth rate is not stated as the measure for calculating the
annual rate of change, the average annual growth rate (linear measure) is used.

B.8 Confidence intervals

A confidence interval is a range of values that is used to describe the uncertainty around an
estimate, usually from a sample survey. Confidence intervals generally describe how different
the estimate could have been if the underlying conditions stayed the same, but variability
in sampling (that is, selecting a different sample from the population) had led to a different
set of data.

Confidence intervals are calculated with a stated probability (commonly 95 per cent); this
means there is a 95 per cent chance that the confidence interval includes the true value.

B.9 Recording of patient information in Client

Management Interface/Operational Data Store
For further information, please refer to <www2.health.vic.gov.au/mental-health/research-and-
reporting/reporting-requirements-for-clinical-mental-health-services>

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B.10 Estimated demand

The Commission estimates that in 2019–20, 209,000 Victorians of all ages had a level of need
for specialist mental health services equivalent to the three highest-intensity consumer
streams described in Chapter 6: The pillars of the new service system—community-based
mental health and wellbeing services. They are the short-term treatment, care and support
stream, the ongoing treatment, care and support stream and the ongoing intensive
treatment, care and support stream.

As shown in Figure 1, of those 209,000 people, Victoria’s current public specialist mental
health services saw only 77,471 (37.1 per cent).

Of those 209,000 people, a further estimated 36,129 people (17.3 per cent) to 75,421 people (36.1
per cent) accessed specialist mental health services in the private health system in 2019–20.
Private specialist mental health services might include mental health services provided in a
private hospital or multiple Medicare-subsidised psychiatric services (refer to Figure 7.1). Such
private services are not accessible to all—for example, those with lower incomes or those in
areas with limited private sector supply.

Figure 1 also shows the service gap—the proportion of those 209,000 people in 2019–20
who were estimated to require services who did not get them in either the public or private
systems. This service gap was estimated to be between 56,108 people (26.8 per cent) and
95,400 people (45.6 per cent).

The second part of Figure 1 shows that in 2019–20 public specialist mental health services
delivered only 1,411,000 (30.0 per cent) of the estimated 4,702,000 hours of care required by
Victorians. This data does not include the gaps in access to wellbeing supports. This suggests
that many people who need these services are not getting them.

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Figure 1:  The difference between the actual number of people receiving specialist mental
health services/actual consumer-related community service hours delivered
and estimated demand, all ages, Victoria, 2010–11 to 2019–20

A. Consumers

B. Service hours

Source: A. Calculation by the Commission based on Department of Health (Commonwealth), National Mental Health
Service Planning Framework; Australian Bureau of Statistics, Australian Demographic Statistics, June 2020, cat. no.
3101.0, Canberra; Department of Health and Human Services, Client Management Interface/Operational Data Store
2010–11 to 2019–20; Department of Health and Human Services, Victorian Admitted Episodes Dataset, 2010–11 to
2018–19; Australian Government Services Australia, Medicare Benefits Schedule, 2017–18.
B. Calculation by the Commission based on Department of Health (Commonwealth), National Mental Health Service
Planning Framework; Australian Bureau of Statistics, Australian Demographic Statistics, June 2009 to June 2019, cat.
no. 3101.0, Canberra; Department of Health and Human Services, Client Management Interface/Operational Data Store
2010–11 to 2019–20.

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Note: 2010–11, 2012–13, 2015–16 and 2016–17 data collection was affected by protected industrial action. The collection
of non-clinical and administrative data (public specialist mental health services) was affected, with impacts on the
recording of community mental health service activity and client outcome measures.
A. Consumers: The estimated number of private clients using the private system is based on the proportion of overall
people admitted to a private hospital in Victoria for a mental health reason between 2010–11 and 2018–19. There may
be consumers receiving mental health services in both public and private specialist services that are double counted.
There may also be people receiving specialist mental health services from other private providers that are not
counted with this methodology.
This analysis does not include ‘unregistered clients’. Each year there are a number of contacts delivered to consumers
that are not registered in the Client Management Interface/Operational Data Store which in 2019–20 was 16 per cent of
total contacts.
For 2019–20, there are two alternative estimates of the number of private specialist mental health consumers in
2019–20. First, 36,129 consumers which would mean there is an estimated gap of 95,400. This estimate is based on
the proportion of people that had a mental health admission to a private hospital. Second, 75,421 consumers which
would mean there is an estimated gap of 56,108. This includes all people that received more than one service from a
medicare-subsidised psychiatrist or had a mental health-related admission to a private hospital. Anyone that also
received public specialist mental health services has been excluded to avoid double counting.
B. Service hours: Some of the gap may be met through services delivered in the private mental health system
Consumer-related service hours are defined in the National Mental Health Service Planning Framework as time
spent working with or for a client. This includes direct activity, for example assessment, monitoring, and ongoing
management, care coordination and liaison, respite services, therapies, peer work, review, intervention, prescriptions,
pharmacotherapy reviews, carer peer work and support services and community treatment teams. It does not include
administration, training, travel, clinical supervision and other activities that do not generate reportable activity on a
consumer’s record.

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B.11 Diagnosis trends

The International Classification of Diseases and Related Health Problems, 10th Revision,
Australian Modification (ICD-10-AM) classifies diagnosis as follows: anxiety disorders includes
generalised anxiety disorders, social phobias, specific phobias and panic disorders; disorders
of childhood and adolescence includes attention deficit hyperactivity disorder and conduct
disorder; disorders of psychological development include developmental language disorder,
learning disorders and autism spectrum disorders; eating disorders include anorexia and
bulimia nervosa; mood disorders includes depressive and bipolar disorders; organic disorders
includes dementia, delirium, disorders due to medical conditions; personality disorders
includes dissocial personality disorder and borderline personality disorder; schizophrenia
and other psychotic disorders includes acute psychotic disorders, schizoaffective, etc; stress
and adjustment disorders includes acute and/or severe stress, post-traumatic stress or
adjustment disorders; substance abuse disorders includes behaviour patterns associated
with alcohol, cannabis, hallucinogens, inhalants, opioids, stimulants etc; other includes
disorders not classified elsewhere; and not recorded includes cases where diagnosis was not
recorded due to collection error or the case did not warrant the allocation of a diagnosis.

Figure 2 shows the principal diagnosis trends of people treated by the public specialist
mental health system, Victoria, 2010–11 and 2019–20.

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Figure 2:  Principal diagnosis trends of people treated by the public

specialist mental health system, Victoria, 2010–11 and 2019–20

Source: Department of Health and Human Services, Client Management Interface/Operational Data Store, 2010–11
and 2019–20.
Note: The reported diagnosis is recorded based on the International Classification of Diseases and Related Health
Problems, 10th Revision, Australian Modification (ICD-10-AM). A diagnosis is the decision reached by the treating
clinician, after assessment, of the nature and identity of the disease or condition of a patient. It represents the major or
principal condition and other primary conditions, complications or comorbidities and associated conditions treated or
investigated during the relevant episode of care. Diagnoses must be coded in accordance with the Victorian additions to
the Australian coding standards and the Department of Health and Human Services ICD: clinical coding information.
The Commission acknowledges the concerns of many consumers about their lack of involvement in diagnostic
processes and the impacts of these labels on them. Terms such as ‘disorder’ can be pathologising and stigmatising, so
the Commission retains them only if others use them to convey a specific meaning.
Since 2014–15, data quality improvements have reduced the proportion of ‘not recorded’ diagnosis.
Methodology to derive principal diagnosis based on the Department of Health and Human Services Mental Health
Services Annual Report approach.

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B.12 COVID-19 Restrictions

Stage 3 COVID-19 restrictions: Was implemented on 30 March 2020 and again on 8 July 2020
for metropolitan Melbourne and allowed people to leave their home for only four reasons:
work, caregiving or receiving, exercise and shopping for essential goods and services.

Stage 4 COVID-19 restrictions: Was implemented on 4 August 2020, and in addition to the
restrictions under Stage 3, additional restrictions limited travel to up to 5 kilometres from a
person’s home for necessary goods and services. Only one person per household could leave
home to shop once per day. Curfews were in place from 8:00 pm to 5:00 am every night to
reduce the number of people leaving their homes and moving around.

Second step: Was implemented on 13 September 2020 for regional Victoria and on 28
September 2020 for metropolitan Melbourne, and eased restrictions with a strong focus on
moving activity into outdoor well-ventilated, outdoor areas wherever possible. The second-
step restrictions balanced population mobility and wellbeing while ensuring the infection
rates were driven down.

Third step: Was implemented on 16 September 2020 for regional Victoria and on 27 October
2020 for metropolitan Melbourne, and eased restrictions with a focus on reopening core
components of the economy in a safe and steady way. A key milestone during this step
was the alignment of metropolitan Melbourne and regional Victoria restrictions on 8
November 2020.

Last step: Was implemented on 22 November 2020, and eased restrictions with a focus on
enhancing social interactions such as increasing private gathering limits and permitting non-
contact and contact sports, as well as further changes to support Victoria’s economic revival.

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Appendix C:
Consultation and engagement

Appendix C.1 Community consultations

undertaken by the Royal Commission
The Commission hosted 61 community consultations between 5 April and 22 May 2019 across
the 21 locations.

Community consultation Community consultation

5 April 2019 – Whittlesea 8 May 2019 – Preston

9 April 2019 – Pakenham 9 May 2019 – Werribee

11 April 2019 – Warrnambool 9 May 2019 – Melbourne

11 April and 12 April 2019 – Hamilton 14 May 2019 – Healesville

15 April 2019 – Geelong 14 May 2019 – Seymour

16 April 2019 – Ballarat 16 May 2019 – Shepparton

17 April 2019 – Sunshine 17 May 2019 – Bendigo

1 May 2019 – Mildura 20 May 2019 – Box Hill

1 May 2019 – Swan Hill 21 May 2019 – Sale

3 May 2019 – Melbourne 22 May 2019 – Warragul

8 May 2019 – St Kilda

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Appendix C.2 Site visits undertaken by the Royal Commission

The Commission undertook the following site visits over 2019 and 2020.

Site visit Site visit

19 March 2019 – Alfred Health 14 May 2019 – Goulburn Valley Health

28 March 2019 – Thomas Embling Hospital 20 May 2019 – Monash Clayton

4 April 2019 – Eastern Health Linwood 5 June 2019 – Royal Children’s Hospital
Prevention and Recovery Care Facility

10 April 2019 – Ravenhall Prison 6 June 2019 – Royal Melbourne Hospital and
Waratah Clinic

10 April 2019 – Dame Phyllis Frost Prison 7 June 2019 – St Vincent’s Safe Haven Café

12 April 2019 – National Centre for 17 September 2019 – Odyssey, New Zealand
Farmer Health

1 May 2019 – Swan Hill Aboriginal District 17 September 2019 – Piri Pono, New Zealand
Health Service

1 May 2019 – Mildura Base Public Hospital 18 December 2019 – Magistrates’ Court of
(mental health ward and Aboriginal Victoria (Assessment and Referral Court
Healing Place) (ARC) list)

9 May 2019 – Mercy Hospital, Werribee 10 March 2020 – Foundation House

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Appendix C.3 Witnesses at the

Commission’s public hearings 2019
Between 2 and 26 July 2019 the Royal Commission conducted its first round of public
hearings. The names of the witnesses who appeared at the public hearings are listed in
the table.

Title Name Role Hearing date

Commissioner Ro Allen Victorian Commissioner for Gender and 17 July 2019

Sexuality

Ms Ingrid Amann Program Coordinator, North Fitzroy, Prevention 10 July 2019

and Recovery Care, Wellways

Ms Jane Anderson Latrobe Health Advocate 19 July 2019

Dr Ravi Bhat Divisional Clinical Director, Goulburn Valley Area 15 July 2019
Mental Health Service, Goulburn Valley Health

Dr Michelle Blanchard Deputy CEO, SANE Australia and Founding 3 July 2019
Director, Anne Deveson Research Centre

Dr Gaynor Blankley Deputy Clinical Services Director, Mercy Mental 5 July 2019
Health and Head of Perinatal Mental Health

Mr Daniel Bolger Witness 2 July 2019

Ms Gail Bradley Interim Operations Director, NorthWestern 9 July 2019

Mental Health Service, Melbourne Health

Dr Peggy Brown AO Psychiatrist who has held a number of 24 July 2019

leadership roles in the mental health sector

Associate Peter Burnett Director, Clinical Governance, NorthWestern 23 July 2019

Professor Mental Health, Melbourne Health

Mr Adam Burns Senior Mental Health Clinician, Wadamba 16 July 2019

Wilam, Melbourne Health

Mr Matiu Bush Founder, One Good Street and Deputy Director, 19 July 2019
Health Transformation Lab, RMIT

Ms Janet Butler Witness 9 July 2019

Scientia Helen Christensen Director and Chief Scientist, Black Dog Institute 19 July 2019
Professor AO

Dr Neil Coventry Chief Psychiatrist, Department of Health and 8 July 2019

Human Services

Mr Bruce Crossett Acting CEO, Transport Accident Commission 23 July 2019

Ms Elizabeth Crowther CEO, Wellways Australia 10 July 2019

Ms Rose Cuff State-wide Coordinator, Families where a Parent 12 July 2019

has a Mental Illness (FaPMI) and Executive
Director and co-founder, Satellite Foundation

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Title Name Role Hearing date

Ms Julie Dempsey Witness 26 July 2019

Dr Paul Denborough Clinical Director, Alfred Child and Youth Mental 9 July 2019
Health Service and Headspace, Alfred Health

Ms Kate Dillon* Witness 12 July 2019

Mr Jeremy Dwyer Manager, Suicide, Mental Health and General 22 July 2019
Investigations, Coroners Prevention Unit,
Coroners Court of Victoria

Ms Vrinda Edan Acting CEO, Victorian Mental Illness Awareness 11 July 2019
Council Inc.

Ms Nina Edwards* Witness 26 July 2019

Ms Aunty Nellie Flagg Witness; respected Elder and a Taylor-Charles 16 July 2019

Dr Louise Flynn Manager, Support After Suicide, Jesuit Social 23 July 2019
Services

Professor David Forbes Clinical Psychologist and Director, Phoenix 4 July 2019
Australia Centre for Posttraumatic Mental
Health

Mr Alistair Gabb Witness 15 July 2019

Dr Graham Gee Clinical Psychologist and Senior Research 16 July 2019

Fellow, Murdoch Children’s Research Institute

Ms Louise Glanville CEO, Victoria Legal Aid 11 July 2019

Mr Andrew Greaves Auditor-General, Victorian Auditor-General’s 25 July 2019

Office

Dr Chris Groot Lecturer, Melbourne School of Psychological 3 July 2019

Sciences, University of Melbourne

Ms Georgie Harman CEO, Beyond Blue 4 July 2019

Ms Georgia Witness 10 July 2019

Harraway-Jones

Dr Richard Haslam Director, Mental Health, Royal Children’s 5 July 2019

Hospital, Melbourne

Professor Helen Herrman AO Academic and President, World Psychiatric 4 July 2019
Association

Ms Melanie Hill* Witness 4 July 2019

Professor Malcolm Hopwood Director, Professional Psychiatry Unit, Albert 10 July 2019
Road Clinic and Ramsay Health Care Professor
of Psychiatry, University of Melbourne

Dr Gerard Ingham General Practitioner 15 July 2019

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Title Name Role Hearing date

Mr Andrew Jackomos Executive Director, Aboriginal Economic 16 July 2019

PSM Development, Department of Jobs, Precincts
and Regions; a Yorta Yorta man

Mr Rod Jackson Witness 22 July 2019

Ms Sally Jennings* Witness 11 July 2019

Dr Caroline Johnson General Practitioner 9 July 2019

Ms Nicole Juniper Witness 2 July 2019

Dr Alison Kennedy Research Fellow, Faculty of Health and National 15 July 2019
Centre for Farmer Health, Deakin University

Ms Helen Kennedy Chief Operations Officer, Victorian Aboriginal 16 July 2019

Community Controlled Health Organisation; a
Trawlwoolway woman

Ms Emma King CEO, Victorian Council of Social Service 19 July 2019

The Hon. Robert Knowles AO A former Victorian Minister whose 24 July 2019
responsibilities included the Health and Aged
Care portfolios

Ms Katerina Kouselas Witness 23 July 2019

Ms Katie Larsen General Manager, Diversity, Inclusion and 17 July 2019

Participation, Mind Australia Limited

Dr Margaret Leggatt Founding Director, Wellways Australia, Founder 12 July 2019

AM and patron, SANE Australia and Board member,
Tandem

Ms Tamara Lovett Witness and a Gunai and Gunditjmara woman 16 July 2019

Ms Anne Lyon Executive Director, Mental Health and Alcohol 23 July 2019
and Other Drugs, Eastern Melbourne Primary
Health Network

Mr David Martine PSM Secretary, Department of Treasury and Finance 26 July 2019

Ms Janet Meagher AM Advocate for people with lived experience of 3 July 2019
mental illness

Ms Adriana Mendoza Manager, Victorian Transcultural Mental Health 18 July 2019

Mr Shaun McClare Principal, Kalinda Primary School 5 July 2019

Professor Patrick McGorry Professor of Youth Mental Health, The University 5 July 2019
AO of Melbourne and Executive Director, Orygen

Mr John McLaren Community Manager, St Vincent’s Area Mental 23 July 2019

Health, St Vincent’s Hospital Melbourne

Mr Gregory McMahon Executive Principal, Hallam Senior College and 19 July 2019
Strategic Director, Doveton College

Dr Ruth McNair AM General Practitioner 17 July 2019

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Title Name Role Hearing date

Professor Helen Milroy Professor of Child and Adolescent 16 July 2019

Psychiatry, University of Western Australia
and Commissioner, National Mental Health
Commission; a descendant of the Palyku people
of the Pilbara region

Mr Jesse Morgan Witness 12 July 2019

Ms Tracey Morgan Community Mental Health Services Manager, 11 July 2019

Casey Area Mental Health Service, Monash
Health

Ms Amelia Morris Witness 5 July 2019

Mr John Murray* Witness 12 July 2019

Dr Gerry Naughtin Held a number of leadership roles across the 24 July 2019
mental health and community sectors

Ms Kali Paxinos Witness 18 July 2019

Ms Kym Peake Secretary, Department of Health and Human 25 July 2019

Services

Ms Mary Pershall Witness 12 July 2019

Professor Jane Pirkis Director, Centre for Melbourne Health, 22 July 2019
Melbourne School of Population and Global
Health, University of Melbourne

Ms Marie Piu CEO, Tandem 18 July 2019

Adjunct David Plunkett CEO, Eastern Health 24 July 2019

Professor

Associate Nicola Reavley Head, Population Mental Health Unit and 3 July 2019
Professor Deputy Director, Centre for Mental Health, The
University of Melbourne

The Hon. Andrew Robb AO Former Federal Member of Parliament 2 July 2019

Mr Peter Ruzyla CEO, EACH 10 July 2019

Mr Wayne Schwass Former AFL player and CEO, Puka Up 2 July 2019

Ms Kylie Scoullar General Manager, Direct Services, Foundation 18 July 2019

House

Dr Ainslie Senz Director, Department of Emergency Medicine, 11 July 2019

Footscray Hospital, Western Health

Alex Smith* Witness 17 July 2019

Associate Simon Stafrace Program Director, Alfred Mental and Addiction 8 July 2019
Professor Health, Alfred Health

Associate Dean Stevenson Clinical Services Director, Mercy Mental Health 10 July 2019
Professor

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Title Name Role Hearing date

Associate Michelle Telfer General Paediatrician, Adolescent Medicine 17 July 2019

Professor Physician and Head, Department of Adolescent
Medicine, The Royal Children’s Hospital

Teresa Witness 3 July 2019

Ms Christine Thomas Witness 15 July 2019

Ms Rebecca Thomas* Witness 12 July 2019

Mr Trevor Thomas Witness 15 July 2019

Mr Simon Thomson Regional Director, Ambulance Victoria 11 July 2019

Ms Felicity Topp CEO, Peninsula Health 25 July 2019

Mr Adwin Town Witness 18 July 2019

Ms Susan Trotter* Witness 22 July 2019

Dr Sika Turner Discipline Senior, Adult Mental Health, Monash 9 July 2019
Health

Associate Ruth Vine Executive Director, NorthWestern Mental Health, 8 July 2019
Professor Melbourne Health

Assistant Glenn Weir Assistant Commissioner, Victoria Police 11 July 2019

Commissioner

Mr Terry Welch CEO, Maryborough District Health Service 15 July 2019

Ms Erica Williams Witness 8 July 2019

Ms Jennifer Williams Chair, Northern Health 25 July 2019

AM

Mr Alan Woodward Witness 22 July 2019

Mr George Yengi Witness 18 July 2019

Note: ‘*’ notes where a pseudonym has been used.

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Appendix C.4 2020 witnesses

(statement only and panel hearings)
The following people provided a witness statement. The Commission held eight
panel hearings.

Title Name Role Hearing date

Ms Lynne Allison Associate Program Director, Eastern Health,

Child, Youth Mental Health Service

Professor Mario Alvarex- Director, Orygen Digital

Jimenez

Ms Julie Anderson Senior Consumer Advisor, Office of the Chief 16 June 2020
Mental Health Nurse and the Office of the Chief
Psychiatrist, Department of Health and Human
Services

Ms Alice Andrews Director, Education, Value Institute for Health

and Care, and Assistant Professor, Department
of Medical Education, Dell Medical School,
University of Texas

Lisa Annese and CEO, Diversity Council Australia (Lisa) and

David Morrison AO Chair, Board of the Diversity Council Australia
(David)

Mr Paris Aristotle AO CEO, Victorian Foundation for Survivors of

Torture (Foundation House)

Associate Jo-An Atkinson Managing Director, Computer Simulation and

Professor Advanced Research Technologies and Head of
Systems Modelling and Simulation, Brain and
Mind Centre, University of Sydney

Ms Lucy Barker* Witness

Ms Nicole Chief Executive, cohealth 24 June 2020

Bartholomeusz

Ms Rachel Bateman* Witness

The Kevin Bell AM QC Director, The Castan Centre for Human Rights
Honourable Law, Monash University
Professor

Mr Sam Biondo Executive Officer, Victorian Alcohol and Drug

Association

Professor Bruce Bonyhady Executive Chair, Melbourne Disability Institute,

AM The University of Melbourne

Professor George Braitberg Executive Director, Strategy, Quality and

AM Improvement, The Royal Melbourne Hospital

Mr John Brogden AM Chairman, Lifeline Australia

Mrs Lucinda Brogden Chair, National Mental Health Commission

AM

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Volume 5 Appendices

Title Name Role Hearing date

Professor Lisa Brophy Discipline Lead in Social Work and Social Policy, 20 May 2020
Department of Occupational Therapy, Social
Work and Social Policy, La Trobe University

Ms Rita Brown President, Australian BPD Foundation

Mr Bill Buckingham Director, Buckingham Consulting

Ms Amelia Callaghan Director, Clinical Service Innovation, Orygen 25 June 2020

Emeritus Terry Carney AO Professor of Law, University of Sydney Law

Professor School

Mr Matthew Carroll President, Mental Health Tribunal 20 May 2020

Dr Emma Cassar Commissioner of Corrections Victoria,

Department of Justice and Community Safety

Professor David Castle Consultant Psychiatrist, St Vincent’s Hospital

Melbourne and Professor of Psychiatry,
University of Melbourne

Dr Enrico Cementon Consultant Psychiatrist, NorthWestern Mental

Health

Dr Kevin Cleary Deputy Chief Inspector, Care Quality

Commission, London

Professor David Coghill Financial Markets Foundation Chair of 23 June 2020

Developmental Mental Health, Royal Children’s
Hospital, Melbourne

Ms Leona Coleman* Witness

Ms Karyn Cook Executive Director, Mental Health Services,

South West Healthcare, Warrnambool
Community Health

Professor David Copolov AO Professor of Psychiatry and Pro Vice Chancellor

Major Campuses and Student Engagement,
Monash University

Mary and Jacob Witnesses

Corbett*

Mr Rick Corney Witness

Aynur and Hafize Witnesses

Coskun

Dr Lynne Coulson Victoria’s Mental Health Complaints

Barr OAM Commissioner

Mr Angus Clelland CEO, Mental Health Victoria

Dr Neil Coventry Chief Psychiatrist, Department of Health and

Human Services

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Royal Commission into Victoria’s Mental Health System

Title Name Role Hearing date

Mr Gary Croton Clinical Nurse Consultant, Human Border

Victorian Dual Diagnosis Initiative, Albury
Wodonga Health

Ms Erin Davies* Witness

Ms Indigo Daya Consumer Academic, Centre for Psychiatric

Nursing, The University of Melbourne

Dr Adam Deacon Child and Adolescent Consultant Psychiatrist,

Alfred Health

Mr Titan Debirioun Witness

Dr Paul Denborough Clinical Director, Alfred Child and Youth Mental 25 June 2020
Health Service and headspace, Alfred Health

Dr Elizabeth Deveny CEO, South Eastern Melbourne Primary Health 24 June 2020
Network

Ms Whitney Dwyer Witness

Ms Honor Eastly Witness

Ms Julie Edwards CEO, Jesuit Social Services 9 June 2020

Dr Shaymaa Elkadi Executive Director, Strategy, Planning and 9 June 2020

Performance, Victorian Institute of Forensic
Mental Health

Ms Katherine Ellis CEO, Youth Affairs Council Victoria

Professor Karen Fisher Professor, Social Policy Research Centre,

University of New South Wales

Mr Robert Fiske CEO, Victorian Health and Human Services

Building Authority

Dr Michael Executive Director, Australian Housing and 2 June 2020

Fotheringham Urban Research Institute

Emeritus Arie Freiberg AM Chair, Sentencing Advisory Council

Professor

Dr Claire Gaskin Forensic Adolescent Psychiatrist, University of

New South Wales

Dr Piers Gooding Research Fellow, Melbourne Social Equity

Institute and the University of Melbourne Law
School

Dr Rob Gordon Clinical Psychologist; President, Australasian

Confederation of Psychoanalytic
Psychotherapies and Consultant to the
Department of Health and Human Services and
Red Cross

Dr Margaret Grigg CEO, Victorian Institute of Forensic Mental 16 June 2020

Health

432
Volume 5 Appendices

Title Name Role Hearing date

Dr Stefan Gruenert CEO, Odyssey House 18 June 2020

Ms Carolyn Gullery Executive Director Planning, Funding & Decision

Support, Canterbury District Health Board, New
Zealand

Ms Marion Hansen Co-Chair, Aboriginal Justice Caucus

Ms Georgie Harman CEO, Beyond Blue

Professor Louise Harms Chair and Head, Social Work, Melbourne School
of Health Sciences, The University of Melbourne

Dr Hila Haskelberg Program Manager, THIS WAY UP, St Vincent’s

Public Hospital Sydney

Ms Lin Hatfield Dodds Associate Dean, Australian and New Zealand

School of Government, Crawford School,
Australian National University

Miss Denna Healy Witness

Mr Justin Heazlewood Witness

Professor Ian Hickie AM Co-Director, Health and Policy, Brain and Mind
Centre, University of Sydney

Ms Kristen Hilton Commissioner, Victorian Equal Opportunity and

Human Rights Commission

Professor Harriet Hiscock Paediatrician, Centre for Community Child 23 June 2020
Health and Director Health Services Research
Unit, Royal Children’s Hospital, Melbourne

Ms Anne Hollonds Director, Australian Institute of Family Studies

Mr Douglas Holmes General Manager, MH-worX, New South Wales

OAM

Ms Tanya Hosch General Manager, Inclusion and Social Policy,

AFL

Ms Catherine CEO, Sacred Heart Mission and Chair of the 2 June 2020
Humphrey Board, Council to Homeless Persons

Ms Erandathie Witness
Jayakody

Ms Sandy Jeffs OAM Witness

Mr Matt Jones Chair, Victorian and Tasmanian Primary Health

Network Alliance and CEO, Murray Primary
Health Network

Miss Emily John* Witness

Professor Shitij Kapur Dean, Faculty of Medicine Dentistry and Health

Sciences and Assistant Vice Chancellor for
Health, University of Melbourne

433
Royal Commission into Victoria’s Mental Health System

Title Name Role Hearing date

Mr Peter Kelly Director Operations, NorthWestern Mental 16 June 2020

Health, Melbourne Health, The Royal Melbourne
Hospital

Ms Sandra Keppich- Director, Operations and Nursing, Mental and

Arnold Addiction Health, Alfred Health

Professor Stuart Kinner Head, Justice Health Unit, Centre for Health
Equity, Melbourne School of Population and
Global Health, University of Melbourne

Dr Nick Kowalenko Senior Clinical Advisor, Emerging Minds

Ms Robyn Kruk AO Interim Chair, Mental Health Australia

Dr Vinay Lakra Clinical Director, North West Area Mental

Health Service, NorthWestern Mental Health,
Melbourne Health

Mr Patrick Lawrence CEO, First Step

Dr Stuart Lewena Director, Emergency Medicine, The Royal

Children’s Hospital

Ms Kim Little Deputy Secretary, Early Childhood Education,

Victorian Department of Education and
Training

Mr Chris Lockwood National CEO, MATES in Construction Australia,

Queensland

Professor Dan Lubman Executive Clinical Director, Turning Point, 18 June 2020
Eastern Health and Professor of Addiction
Study and Services, Monash University

Professor Sir Michael Marmot Director, Institute of Health Equity at University

College London

Mr Tim Marney Principal, Nous Group

Dr Christopher Senior Lecturer in Social Work, RMIT University, 20 May 2020

Maylea Chair, Committee of Management, Victorian
Mental Illness Awareness Council

Ms Peta McCammon Associate Secretary, Department of Justice and

Community Safety

Professor Patrick McGorry Professor of Youth Mental Health, University of

AO Melbourne and Executive Director, Orygen

Professor Alexander Professor of Psychiatry, School of Medicine,

McFarlane AO University of Adelaide

Professor Graham Meadows Professor of Psychiatry, Monash University

School of Clinical Sciences, Monash Health

Ms Sue Medson OAM CEO, Gippsland Lakes Complete Health

Dr Robyn Miller CEO, MacKillop Family Services

434
Volume 5 Appendices

Title Name Role Hearing date

Professor Rob Moodie Deputy Head of School and Professor of Public

Health, University of Melbourne

Dr Tim Moore Senior Research Fellow

Ms Christine Morgan CEO, National Mental Health Commission

Tass Mousafaredis Chair of the Board, Star Health (Tass) and

and Kent Burgess Acting CEO, Star Health (Kent)

Associate Steven Moylan Clinical Director, Mental Health, Drug and 24 June 2020
Professor Alcohol Services, Barwon Health

Professor Louise Newman Professor of Psychiatry, University of Melbourne 23 June 2020

AM and a practising perinatal and infant clinician 

Professor Richard Newton Clinical Director, Peninsula Mental Health

Service

Mr Dan Nicholson Executive Director, Criminal Law, Victoria Legal 9 June 2020
Aid

Professor Frank Oberklaid Paediatrician, Royal Children’s Hospital,

AM OAM Melbourne and Co-Group Leader of Child
Health Policy, Equity and Translation, Murdoch
Children’s Research Institute

Distinguished James Ogloff AM Executive Director, Victorian Institute of

Professor Forensic Mental Health and Distinguished
Professor, Centre for Forensic Behavioural
Sciences, Swinburne University

Ms Mary O’Hagan Manager Mental Wellbeing, Te Hiringa Hauora,

MNZM New Zealand

Dr Brendan O’Hanlon Mental Health Program Manager, Bouverie

Centre, La Trobe University

Ms Mary-Ann Deputy Secretary, Skills and Higher Education,

O’Loughlin AM New South Wales Department of Education

Mr Mark Orr AM CEO, Flourish Australia and Board Director,

Mental Health Coordinating Council

Mr Graham Panther Witness

Ms Kym Peake Secretary, Department of Health and Human

Services

Mr David Pearl Innovator, Author and Public Speaker of The

Studios, London

Mr Dave Peters Witness

Dr Melissa Petrakis Chair, Tandem

Dr Sarah Pollock Executive Director, Research and Advocacy, 2 June 2020

Mind Australia

435
Royal Commission into Victoria’s Mental Health System

Title Name Role Hearing date

Ms Elizabeth Porter* Witness

Mr Frank Quinlan Former CEO of Mental Health Australia

Mr Colin Radford CEO, Victorian WorkCover Authority

Associate Alessandra Director, Mindful, The University of Melbourne 25 June 2020

Professor Radovini and Consultant Psychiatrist, Orygen

Professor Neil Rees Witness

Mr Kiba Reeves Witness

Dr John Reilly Chief Psychiatrist, Queensland 18 June 2020

Dr Sara Renwick-Lau General Practitioner, Mallacoota Medical Centre

Aaron and Kristy Witnesses

Robinson*

Ms Cath Roper Consumer Academic, Centre for Psychiatric

Nursing, University of Melbourne

Professor Alan Rosen AO Professorial Fellow, Illawarra Institute for Mental

Health, University of Wollongong and Clinical
Associate Professor, Brain and Mind Centre,
Sydney Medical School, University of Sydney

Miss Jennifer Rowan Witness

Dr Christopher Ryan Consultation-Liaison Psychiatrist, Westmead

Hospital, Sydney

Ms Nicole Sadler Head, Policy and Practice, Phoenix Australia,

Centre for Posttraumatic Mental Health

Ms Eva Sifis Witness

Mr Michael Silva* Witness

Professor Bruce Singh AM Clinical Director, Mental Health Services, South

Emeritus West Healthcare, Warrnambool

Associate Dan Siskind Clinical Academic Psychiatrist, Princess

Professor Alexandra Hospital

Ms Jenny Smith CEO, Council to Homeless Persons

Mr Shane Solomon Partner, Caligo Health

Associate Simon Stafrace Chief Adviser, Mental Health Reform Victoria

Professor

Dr Danny Sullivan Executive Director, Clinical Services, Victorian

Institute of Forensic Mental Health

436
Volume 5 Appendices

Title Name Role Hearing date

Professor Suresh Sundram Head, Department of Psychiatry, School of

Clinical Sciences, Monash University and
Director, Research, Mental Health Program,
Monash Health

Mr Terry Symonds Deputy Secretary, Health and Wellbeing,

Department of Health and Human Services

Dr Tricia Szirom CEO, Victorian Mental Illness Awareness Council

Professor Robert Thomas Deputy Chairperson, Victorian Comprehensive

OAM Cancer Centre

Mr Grant Todd* Witness

Dr Mariam Tokhi General Practitioner, DPV Health

Mr Jason Trethowan CEO, headspace

Mr Nathan Turner* Witness

Associate Ruth Vine Director, Victorian Institute of Forensic Mental 20 May 2020
Professor Health

Ms Lynda Watts Witness

Professor Penny Weller Professor, Centre for Business and Human

Rights RMIT University

Ms Catherine White Witness

Ms Sue Williams CEO, Cabrini Health Australia and Board

Member, Victorian Institute of Forensic Mental
Health

Mr Jim Williamson Witness

Ms Anna Wilson* Witness

Note: ‘*’ notes where a pseudonym has been used.

437
Royal Commission into Victoria’s Mental Health System

Appendix C.5 Roundtables and attendees

The Commission held a total of 56 roundtables during its inquiry; 17 were held across May–
‌December 2019, and 39 across February–October 2020.

Engagement Date Title or topic Attendees

Roundtable 21 May Traralgon/Latrobe • Jane Anderson, Latrobe Health Advocate

2019 community • Alistair Edgar, Senior Advisor, Latrobe Health
Advocate
• Ange Gordon, Community Board Member, Latrobe
Health Assembly
• Jonathan Armstrong, Community Board Member,
Latrobe Health Assembly
• Linda Reid, Community Board Member, Latrobe
Health Assembly
• Ian Needham, Executive Officer, Latrobe Health
Assembly
• Carolyn Whalan, Coordinator, The Gathering Place
• Brendan Witt, Senior Alcohol and Other Drugs
Clinician, Gippsland and East Gippsland Aboriginal
Co-Operative
• Ray Naidu, Ramahyuck District Aboriginal
Corporation
• Maria Garrett, Population Health Planner, Gippsland
Primary Health Network
• Sharon Fisher, Department of Health and Human
Services

Roundtable 14 July Maryborough • Terry Welch, CEO, Maryborough District Health

2019 District Health Service
• Nickola Allan, Director, Clinical Services,
Maryborough District Health Service
• Lucy Roffey, CEO, Central Goldfields Shire
• Sharyn Huggett, Coordinator, Go Goldfields, Central
Goldfields Shire
• Paul Huggett, Senior Sergeant, Victoria Police
• Garry Higgins, Member, Committee for Maryborough
• David Sutton, Principal, Maryborough Education
Centre
• Teresa Bourke, Carer Representative, Tandem

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Volume 5 Appendices

Engagement Date Title or topic Attendees

Roundtable 20 August Lived experience • Julie Anderson, Senior Consumer Advisor, Office of
2019 workforce the Chief Mental Health Nurse, Department of Health
and Human Services
• Wanda Bennetts, Senior Consumer Consultant,
Independent Mental Health Advocacy
• Cate Bourke, Manager and Consumer Carer, Eastern
Health
• Emma Cadogan, Senior Policy Advisor, Lived
Experience Strategy, Department of Health and
Human Services
• Bianca Childs, Peer Practice Advisor, Mind Australia
• Lorna Downes, Family/carer Workforce Development
Coordinator, Centre for Mental Health Learning
• Julie Dempsey, Senior Consumer Consultant,
Forensicare
• Vrinda Edan, Acting CEO, Victorian Mental Illness
Awareness Council Inc.
• Jacinta Kuklych, Carer Lived Experience Workforce
Network, Tandem
• Jen Maries, Consumer Peer Support Worker,
NorthWestern Mental Health
• Donna Mathews, Lived Experience Manager, Barwon
Health
• Catherine Minshall, Consumer Researcher, Recovery
and Social Justice Unit, Centre for Mental Health,
University of Melbourne
• Rory Randall, Peer Support Worker, Prevention and
Recovery Care, Neami National
• Melanie Ryan, Family/Carer Peer, Peninsula Health
Mental Health Service
• Michelle Swann, Board Chair, Tandem
• Scott Walker, CEO, Carers Victoria
• Craig Wallace, Consumer Workforce Development
Coordinator, Centre for Mental Health Learning

439
Royal Commission into Victoria’s Mental Health System

Engagement Date Title or topic Attendees

Roundtable 21 August Doctors workforce • Dr Lee Allen, Director, Training/Psychiatry, Western

2019 Region, Austin Health
• Dr Cathy Andronis, Royal Australian College of
General Practitioners (Victoria)
• Dr Dominika Baetens, Consultant Psychiatrist, St
Vincent’s Hospital Melbourne
• Professor Andrew Chanen, Head, Personality Disorder
Research, Orygen
• Janelle Devereux, Executive Director, Health Systems
Integration, North Western Melbourne Primary Health
Network
• Dr Jennie Hutton, Australasian College of Emergency
Medicine
• Dr Niroshini Kennedy, Royal Australasian College of
Physicians
• Dr Vinay Lakra, College Psychiatrists President elect
(Vic) and Director, Clinical Services, Melbourne Health
• Dr Steven Moylan, Director, Clinical Services, Barwon
Health
• Professor Richard Newton, Chair, Royal Australian
and New Zealand College of Psychiatry (Victoria)
• Dr Daniel O’Connor, Office of the Chief Psychiatrist,
Department of Health and Human Services
• Professor John Prins, Head, Melbourne Medical
School, University of Melbourne
• Dr Anoop Raveendram, Director, Clinical Services,
Ballarat Health Services
• Dr Sudeep Saraf, Head, Community Psychiatry, Alfred
Health
• Dr Ajit Selvendra, Psychiatrist, Australian Medical
Association (Victoria)
• Dr Danny Sullivan, Executive Director, Clinical
Services, Forensicare

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Volume 5 Appendices

Engagement Date Title or topic Attendees

Roundtable 21 August Nurses workforce • Duncan Baulch, Manager, Nursing and Midwifery
2019 Special Projects, Safer Care Victoria
• Melanie Bish, Senior Lecturer, Rural Nursing and
Midwifery, La Trobe University
• Pip Carew, Assistant Secretary, Australian Nursing
and Midwifery Federation (Victoria)
• Associate Professor Alicia Evans, Head, School of
Nursing, Midwifery and Paramedicine, Australian
Catholic University
• Professor Kim Foster, Professor, Mental Health
Nursing, Australian Catholic University and North
Western Mental Health
• Professor Richard Gray, Mental Health, Nursing and
Midwifery, La Trobe University
• Dr Bridget Hamilton, Centre of Psychiatric Nursing,
University of Melbourne
• Stewart Imrie, Nurse Unit Manager, Child and
Adolescent Mental Health Service, Monash Health
• Brian Jackson, Director, Nursing, Melbourne Health
• Anna Love, Chief Mental Health Nurse, Department of
Health and Human Services
• Andrew Morgan, Workplace Representative, Mental
Health Triage and ED Response Service (Victoria)
• Professor Nikki Phillips, Head of School, Nursing and
Midwifery, Deakin University
• Jo Ryan, Director of Nursing, Forensicare
• Honie Thomson, Nurse Unit Manager, Adult Acute,
Peninsula Health
• Fiona Whitecross, Acute Services Manager, Alfred
Health

441
Royal Commission into Victoria’s Mental Health System

Engagement Date Title or topic Attendees

Roundtable 22 August Health • Kamal Bekhazi, Senior Research and Projects Officer,
2019 professionals Health Workers Union
• Sarah Castle, Mental Health Nurse and Member,
Health and Community Services Union
• Professor Kim Cornish, Head of School, Psychological
Sciences, Monash University
• Professor Ellie Fossey, Head of Department and
Graduate Research Coordinator, Monash University
• Professor Louise Harms, Chair and Head,
Department of Social Work, University of Melbourne
• Paul Healey, Acting State Secretary, Health and
Community Services Union
• Dr Rosemary Kelly, Secretary, Victorian Psychologists
Association
• Kate Lheude, Occupational Therapist, Melbourne Health
• Craig McGregor, Secretary, Victorian Allied Health
Professionals Association
• Associate Professor Melissa O’Shea, Deakin
University
• Debra Parnell, Manager, Social Policy and Advocacy,
Australian Association of Social Workers
• Rachel Starbuck, Occupational Therapist,
St Vincent’s Health
• Jacqueline White, Victorian State Chair, Australian
Psychological Society
• Leon Wiegard, Assistant Branch Secretary, Australian
Services Union
• Professor Sarah Wilson, Head of School,
Psychological Sciences, University of Melbourne

442
Volume 5 Appendices

Engagement Date Title or topic Attendees

Roundtable 27 August Culturally and • Zuleika Arashiro, Advocacy Leader, Ethnic

2019 linguistically Communities’ Council of Victoria
diverse people • Paris Aristotle AO, CEO, Victorian Foundation for
and communities Survivors of Torture Inc. (Foundation House)
• Rebecca Eckard, Director, Policy and Research,
Refugee Council of Australia
• Carmel Guerra OAM, CEO, Centre for Multicultural
Youth
• Demos Krouskos, CEO, Centre for Culture, Ethnicity
and Health
• Adriana Mendoza, Manager, Victorian Transcultural
Mental Health
• Adele Murdolo, CEO, Multicultural Centre for Women’s
Health
• Associate Professor Harry Minas, Director, Centre for
Mental Health (Global and Cultural Mental Health
Unit), University of Melbourne
• Dr Tram Nguyen, Medical Director, Cabrini Asylum
Seeker and Refugee Health Hub
• Silvio Pontonio, Acting CEO, Spectrum
• Ela Stewart, Policy Officer, InTouch Multicultural
Centre against Family Violence
• Hakki Suleyman, Chairperson, Migrant Resource
Centre, North West Region Inc.
• Sylvia Wan, Manager, Health and Wellbeing, Southern
Migrant and Refugee Centre
• Professor Suresh Sundram, Head, Department of
Psychiatry, School of Clinical Sciences, Monash
University and Director of Research, Mental Health
Program, Monash Health
• Denise Goldfinch, Executive Officer, Diaspora Action
Australia

Roundtable 28 August Aboriginal people • Raelene Stephens, Nurse Manager, Social and
2019 and communities Emotional Well-Being Team, Mallee and District
Aboriginal Services
• Wayne Freeman, Senior Adviser, Commission for
Children and Young People
• Michael Graham, Chairperson, Victorian Aboriginal
Health Service
• Daniel Bolger, Community Witness
• Tamara Lovett, Community Witness
• Andrew Jackomos PSM, Executive Director,
Aboriginal Economic Development, Department of
Jobs, Precincts and Regions
• Helen Kennedy, Chief Operations Officer, Victorian
Aboriginal Community Controlled Health
Organisation
• Trevor Pearce, Acting Chief Executive Officer,
Victorian Aboriginal Community Controlled Health
Organisation

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Royal Commission into Victoria’s Mental Health System

Engagement Date Title or topic Attendees

Roundtable 4 LGBTIQ+ people • Commissioner Ro Allen, Victorian Commissioner for

September Gender and Sexuality
2019 • Brenda Appleton, Chair, Transgender Victoria
• Joe Ball, CEO, Switchboard Victoria
• Marina Carmen, Research Fellow, Australia Research
Centre in Sex, Health and Society, La Trobe University
• Nathan Despott, Brave Network
• Dr Jaco Erasmus, Monash Gender Centre
• Karen Field, CEO, Drummond Street
• Caz Healy, Executive Lead Services, cohealth
• Janet Jukes, Lifeworks
• Richard Keane, CEO, Living Positive Victoria
• Kochava Lilit, Committee Member, Bisexual Alliance
Victoria
• Dr Ruth McNair AM, General Practitioner
• Ruby Mountford, President, Melbourne Bisexual
Network
• Micah Scott, CEO, Minus 18

Roundtable 4 Alcohol and other • Laurence Alvis, CEO, UnitingCare Regen

September drugs • Sam Biondo, Executive Officer, Victorian Alcohol and
2019 Drug Association
• Yvonne Bonomo, Director, Department of Addiction,
Medicine, St Vincent’s Hospital
• Emily Box, Coordinator, Alcohol and other Drugs,
North Western Melbourne Primary Health Network
• Andrew Bruun, CEO, Youth Support and Advocacy
Service (YSAS)
• Dr Jon Cook, Head of Unit, Addiction Medicine,
Western Health Services
• Sione Crawford, CEO, Harm Reduction Victoria
• Stefan Gruenert, CEO, Odyssey House
• Anne-Maree Kaser, CEO, Windana
• Professor Nicole Lee, Director, 360Edge
• Rosemary McClean, Self Help Addiction Resource
Centre (SHARC)
• Sue Medson OAM, CEO, Gippsland Lakes Complete
Health
• Stephen McNally, Deputy CEO, Penington Institute
• Mel Thomson, Executive Manager, Youth Services,
Taskforce

444
Volume 5 Appendices

Engagement Date Title or topic Attendees

Workshop 10 Older people • Dr Ravi Baht, Divisional Clinical Director, Goulburn

September Valley Area Mental Health Service, Goulburn Valley
2019 Health
• Dr Catherine Barret, Celebrate Ageing
• Professor Sunil Bhar, Swinburne University, Wellbeing
Clinic for Older Adults
• Heather Birch, Senior Policy Adviser, Commissioner
for Senior Victorians
• Amanda Bond, Carer Representative, Tandem
• Bhim Boodram, Clinical Care Coordinator, Aboriginal
Community Elders Service
• Shellie Braverman, Victorian Mental Illness
Awareness Council Inc.
• Jan Bruce, Positive Ageing Policy Adviser, Municipal
Association of Victoria
• Agnes Chong, Program Officer, Mental Health and
Alcohol and Other Drugs, Eastern Melbourne Primary
Health Network
• Coleen Clare, Chair, The Matrix Guild
• Angus Clelland, CEO, Mental Health Victoria
• Helene Cowley, Chief Social Worker, Aged Persons
Mental Health Program, NorthWestern Mental Health
• Associate Professor Briony Dow, National Ageing
Research Institute
• Debra Fast, Service Manager Mental Health, Baptcare
• Freda Goldbert, Carer Representative, Tandem
• Michael Gourlay, CEO, Elder Rights Advocacy
• Dr David Huppert, Deputy Chief Psychiatrist,
Department of Health and Human Services
• Melanie Joosten, Policy Officer, Senior Rights Victoria
• Sinisha Krstov, Access and Support Worker, Ethnic
Communities’ Council of Victoria
• Tara Laursen, Manager, Mental Health and Alcohol
and Other Drugs, Eastern Melbourne Primary Health
Network
• Anne Muldowney, Senior Policy Advisor, Carers
Australia
• Dr Gerry Naughtin, Strategic Adviser, Mental Health
in the Strategic Advisers and Research Division,
National Disability Insurance Agency
• Donela Perry, Residential Care and Services Manager,
Baptcare
• Dr Chris Plakiotis, Head of Division, Aged Mental
Health Research Unit, Monash University
• Gabriele Rukas, Sector Development, Innovation and
Inclusion, Ethnic Communities’ Council of Victoria
• Helen Small, General Manager Operations,
Wintringham Specialist Aged Care
• Sonya Stanley, Primary Health Network and
Government Engagement Manager, Beyond Blue
• Dr Maria Tsanglis, Director, Aged and Liaison
Psychiatry Service, Alfred Health
• Rhonda Watson, Home and Community Care/
Planned Activity Group Manager, Aboriginal
Community Elders Service

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Royal Commission into Victoria’s Mental Health System

Engagement Date Title or topic Attendees

Roundtable 12 Aboriginal people • Raelene Stephens, Mallee and District Aboriginal

September and communities Services (MDAS)
2019 • Wayne Freeman, Commission for Children and Young
People
• Michael Graham, Victorian Aboriginal Health Service
(VAHS)
• Daniel Bolger, Community Witness
• Tamara Lovett, Community Witness
• Helen Kennedy, Victorian Aboriginal Community
Controlled Health Organisation (VACCHO)
• Trevor Pearce, Victorian Aboriginal Community
Controlled Health Organisation (VACCHO)
• Adam Burns, Wadamba Wilam, NEAMI
• Ruby Warber, Victorian Aboriginal Community
Controlled Health Organisation (VACCHO)
• Jeannie McIntyre, Victorian Aboriginal Health Service
• Shirley Slann, Victorian Aboriginal Child Care Agency
• Claire Horsfall, Victorian Aboriginal Child Care
Agency
• Tracy Mason, Victorian Aboriginal Child Care Agency
• Duane Luki, Wathaurong Aboriginal Co-operative
• Shaun Coade, Wathaurong Aboriginal Co-operative
• Indi Clark, Koori Youth Council
• Banok Rind, Koori Youth Council
• Douglas Briggs, Koori Youth Council

Roundtable 18 Economics • Professor Cathy Mihalopoulos, Chair and Head,

September Deakin Health Economics, Deakin University
2019 • Tim Marney, Principal, Nous Group
• Associate Professor Liz Schroeder, Centre for the
Health Economy and Faculty of Medicine, Macquarie
University
• Professor Martin Knapp, Care Policy and Evaluation
Centre
• Professor Rowena Jacobs, Centre for Health
Economics
• Rosalyn Bell, Assistant Commissioner, Productivity
Commission
• Professor Yuting Zhang, Health Economics, University
of Melbourne
• Professor Leonie Segal, Allied Health and Human
Performance, University of South Australia
• Dr Stephen Duckett, Health Program Director,
Grattan Institute
• Professor Michael Shields, Centre for Health
Economics
• Claire De Oliveira, Centre for Health Economics

446
Volume 5 Appendices

Engagement Date Title or topic Attendees

Roundtable 30 October Neurocognitive • Dr Tareq Abuelroos, Consultant Psychiatrist,

2019 and intellectual Victorian Dual Disability Service
disabilities and • Dr Chad Bennett, Clinical Director, Victorian Dual
mental illness Disability Service
• Professor Andrew Carroll, Chair, Faculty of Forensic
Psychiatry Subcommittee, Royal Australian and New
Zealand College of Psychiatrists
• Evelyn Culnane, Transition Support Service, Royal
Children’s Hospital, Melbourne
• Sarah Forbes, Advocacy Manager, VALiD
• Dr Jennifer Harrison, Neurodevelopmental Stream,
Alfred Health
• Dr Angela Livingston, Consultant Psychiatrist,
Victorian Dual Disability Service
• Colleen Pearce, Public Advocate, Office of the Public
Advocate
• Andrew Pridding, Nurse Practitioner, Victorian Dual
Disability Service
• Fiona Sharkie, CEO, Amaze
• Dr Jane Tracy, Centre of Developmental Disability
Health Victoria
• Andrew Walby, Director, Emergency Department,
St Vincent’s Hospital

447
Royal Commission into Victoria’s Mental Health System

Engagement Date Title or topic Attendees

Roundtable 19 Housing • Chris Hotham, Deputy Secretary, Housing and

November Infrastructure and Director, Housing, Department of
2019 Health and Human Services
• Sherri Bruinhout, Director, Housing Pathways and
Outcomes, Department of Health and Human Services
• Dr Michael Fotheringham, Australian Housing and
Urban Research Institute
• Professor Guy Johnson, Director, Centre for Applied
Social Research, School of Global, Urban and Social
Studies, RMIT
• Jenny Smith, CEO, Council to Homeless Persons
• Lesley Dredge, CEO, Community Housing Industry
Association Victoria
• Amanda Donohoe, CEO, Servants Community Housing
• Ellie Francis-Brophy, State Manager Victoria, Housing
Choices Australia
• Cathy Humphrey, CEO, Sacred Heart
• Trudi Ray, Chief Operations Officer, Haven: Home, Safe
• Darren Smith, CEO, Aboriginal Housing Victoria
• Lesley Tarves, Chief Operating Officer, EACH
Community Housing
• Katheryn Atkinson, Housing Services Manager,
HousingFirst
• Bryan Lipmann, CEO, Wintringham Specialist Aged
Care
• Bevan Warner, CEO, Launch Housing
• Debbie Selman, Team Leader, Homeless Outreach
Psychiatric Service
• Associate Professor Simon Stafrace, Program Director,
Alfred Mental and Addiction Health, Alfred Health
• Dr Sarah Pollock, Executive Director, Research and
Advocacy, Mind Australia
• Maree Bennett, Co-Director, Mental Health, Drugs
and Alcohol Services, Barwon Health
• Susanne Birks, Acting Director, Operations, Alfred
Mental and Addiction Health, Alfred Health
• Jenelle Linton, General Manager, Mental Health and
Addiction Medicine, St Vincent’s Hospital
• Laura Collister, Director, Mental Health, Wellways
• Maryann Croatto, Manager, Community, Mercy
Mental Health

448
Volume 5 Appendices

Engagement Date Title or topic Attendees

Roundtable 12 Criminal justice • Nadia Baille, General Counsel, Forensicare

December services • Sophia Blosfelds, Civil Lawyer, Victorian Aboriginal
2019 Legal Service
• Hannah Brown, Director, Health Policy and Strategy,
Department of Justice and Community Safety
• Laura Burke, Senior Legal Policy Adviser, Federation
of Community Legal Centres
• Emma Cassar, Commissioner, Corrections Victoria,
Department of Justice and Community Safety
• Ariel Couchman, Director, Youth Law
• Karen Fletcher, Managing Lawyer, Public Interest Law,
Fitzroy Legal Service
• Dr Margaret Grigg, CEO, Forensicare
• Monique Hurley, Lawyer, Human Rights Law Centre
• Charlotte Jones, General Manager, Mental Health
Legal Centre
• Sonia Law, Program Manager, Mental Health and
Disability Advocacy, Victoria Legal Aid
• Tim Marsh, Chief Counsel, VLA Chambers, Victoria
Legal Aid
• Serina McDuff, CEO, Federation of Community Legal
Centres
• Catherine Neville, Executive Director, Advocacy and
Strategic Communications, Jesuit Social Services
• Dan Nicholson, Executive Director, Criminal Law
Services, Victoria Legal Aid
• Colleen Pearce, Public Advocate, Office of the Public
Advocate
• Ryan Phillips, Deputy Secretary, Corrections and
Justice Services, Department of Justice and
Community Safety
• Isabel Robinson, Policy, Research and Advocacy
Officer, Victorian Aboriginal Legal Service
• Marius Smith, CEO, Victorian Association for the Care
and Resettlement of Offenders
• Sophia Spada-Rinaldis, Policy Officer, Office of the
Public Advocate
• Brigid Sunderland, Deputy Secretary, Youth Justice,
Department of Justice and Community Safety
• Vaughan Winther, CEO, Australian Community
Support Organisation
• Cath Williams, Chief Operations Officer, Australian
Community Support Organisation

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Engagement Date Title or topic Attendees

Roundtable 18 Court services • Kirsten Aaskov, Principal Solicitor, Policy and

December Specialised Legal Division, Office of Public Prosecutions
2019 • Louise Anderson, CEO, Court Services Victoria
• Sophia Blosfelds, Civil Lawyer, Victorian Aboriginal
Legal Service
• Anna Beesley, Reference Team Leader, Victorian Law
Reform Commission
• Magistrate Jennifer Bowles, Children’s Court of
Victoria
• Kate Bundrock, Program Manager, Summary Crime,
Victoria Legal Aid
• Laura Burke, Senior Legal Policy Adviser, Federation
of Community Legal Centres
• State Coroner John Cain, Coroners Court of Victoria
• Anna Faithfull, Deputy Secretary, Justice Policy and
Data Reform, Department of Justice and Community
Safety
• Paul Gardiner, Superintendent, Victoria Police
• Rebecca Halpin, Priority Communities Division,
Victoria Police
• Magistrate John Hardy, Magistrates’ Court of Victoria
• Sonia Law, Program Manager, Mental Health and
Disability Advocacy, Victoria Legal Aid
• Taryn Lee, Executive Director, Justice System Reform,
Department of Justice and Community Safety
• Peta McCammon, Deputy Secretary, Service Delivery
Reform, Coordination and Workplace Safety,
Department of Justice and Community Safety
• Serina McDuff, CEO, Federation of Community Legal
Centres
• Corri McKenzie, Deputy Secretary, Police, Fines
and Crime Prevention, Department of Justice and
Community Safety
• Dan Nicholson, Executive Director, Criminal Law
Services, Victoria Legal Aid
• Rachel Powning, General Manager, Neighbourhood
Justice Centre
• His Honour Judge Mark Taft, County Court of Victoria
• Nerita Waight, Director, Victorian Aboriginal Legal
Service

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Engagement Date Title or topic Attendees

Roundtable 18 Future focus • Martin Stewart-Weeks

February system • Professor Kim Cornish, Director, Turner Institute and
2020 Hosted by Monash Chair, Million Minds Mission
Sustainable • Kerry Jones, Director Systems Initiatives, The
Development Australian Centre for Social Innovation
Institute
• Professor Janine O’Flynn, Professor of Public
Management, University of Melbourne and Australia
and New Zealand School of Government
• Ben Rimmer, Deputy Secretary and Director, Housing,
Department of Health and Human Services
• The Hon. Jenny Macklin, Former Federal Minister
responsible for National Disability Insurance Scheme
and Vice-Chancellor’s Fellow, Melbourne School of
Government
• Kate Cornick, CEO, LaunchVic
• Chelsea Lang, YLab Manager, Foundation for Young
Australians
• Professor Rod Glover, Monash Sustainable
Development Institute
• Associate Professor Peter Bragge, Senior Research
Fellow, BehaviourWorks Australia, Monash
Sustainability Institute
• Dr Lara Werbeloff, Manager, Strategic Initiatives,
Monash Sustainable Development Institute

Roundtable 26 Future focus • Catherine Keating, Medibank

February system • Robyn Mildon, CEO, Centre for Evidence and
2020 Hosted by Monash Implementation
Sustainable • Professor Sharon Goldfeld, Director, Centre for
Development Community Child Health and Co-Group Leader of
Institute Policy and Equity, Murdoch Children’s Research
Institute
• Graeme Samuel, Chair, Dementia Australia and
Professorial Fellow, Business School and School of
Public Health and Preventative Medicine, Monash
University
• Professor Rob Moodie, Nossal Institute of Global
Health, University of Melbourne
• Dr Jane Burns, Founder, InnoWell Pty Ltd. Young and
Well Cooperative Research Centre
• Ron Ben-David, Head, Essential Services Commission
• Tom Bentley, Executive Director, Policy and Impact
and a Vice-Chancellor’s Innovation Professor, RMIT
University
• Professor Rod Glover, Monash Sustainable
Development Institute
• Sherry-Rose Bih Watts, Foundation for Young
Australians
• Associate Professor Peter Bragge, Senior Research
Fellow, BehaviourWorks Australia, Monash
Sustainability Institute
• James Button, Monash Sustainable Development
Institute
• Mark Elliot, Collabforge

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Engagement Date Title or topic Attendees

Roundtable 9 June Antidiscrimination • The Honourable Professor Kevin Bell QC AM, Director
2020 and human rights Castan Centre for Human Rights Law, Monash
University
• Julian Gardner AM, Royal Commission into Victoria’s
Mental Health System’s Expert Advisory Committee
• Louise Glanville, CEO, Victoria Legal Aid
• Rob Hulls, Director, Centre for Innovative Justice,
RMIT University
• Dr Helen Szoke AO
• Professor Penny Weller, RMIT University
• Stan Winford, Associate Director, Research,
Innovation and Reform, RMIT University

Roundtable 16 June Social • Larry Kamener, Boston Consulting Group

2020 connectedness • Jane-Frances Kelly, Australia and New Zealand
– Community School of Government
wellbeing
• Dr Pradeep Philip, Deloitte Access Economics
• Professor Rob Moodie, Nossal Centre for Global
Health, University of Melbourne
• Elizabeth Deveny, South Eastern Melbourne Primary
Health Network

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Engagement Date Title or topic Attendees

Roundtable 16 June Forensic mental • Julie Dempsey, Senior Consumer Consultant,

2020 health Forensicare
• Donna Vos, Family Carer Consultant, Forensicare
• Professor James Ogloff AM, Executive Director,
Victorian Institute of Forensic Mental Health
and Distinguished Professor, Centre for Forensic
Behavioural Sciences, Swinburne University
• Dr Margaret Grigg, CEO, Forensicare
• Dr Danny Sullivan, Executive Director, Clinical
Services, Forensicare
• Rowan McRae, Executive Director, Civil Law, Victoria
Legal Aid
• Associate Professor Andrew Carroll, Chair, Faculty of
Forensic Psychiatry Subcommittee, Royal Australian
and New Zealand College of Psychiatrists
• Dr Paul Denborough, Clinical Director, Alfred Child
and Youth Mental Health Services and headspace,
Alfred Hospital
• John Chesterman, Office of the Public Advocate
• Jacinta Pollard, CEO, Caraniche
• Frances Diver, CEO, Barwon Health
• Detective Inspector Steven Cooper, Victoria Police
• Emma Cassar, Corrections Commissioner,
Department of Justice and Community Safety
• Hannah Brown, Executive Director, Justice Health,
Department of Justice and Community Safety
• Shane Quinn, Acting Assistant Director, Programs
and Performance, Mental Health Branch, Department
of Health and Human Services
• Anna Love, Chief Mental Health Nurse, Department of
Health and Human Services
• Megan Boland, Acting Assistant Director, System
Performance and Integration, Mental Health Branch,
Department of Health and Human Services
• Vaughan Winther, CEO, Australian Community
Support Organisation
• Anthea Lemphers, Director, Psychological Services,
Forensicare
• Dr Neil Coventry, Chief Psychiatrist, Department of
Health and Human Services
• Dr Kate Roberts, Director, Clinical Services – Prisons,
Forensicare
• Ken Lay AO APM, Board Chair, Forensicare

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Engagement Date Title or topic Attendees

Roundtable 18 June Innovation, hosted • Kate Cornick, CEO, LaunchVic

2020 by LaunchVic • Professor Rod Glover, Director of the Monash
Sustainability Development Institute
• Katie Liddicoat, General Manager, Culture and
Engagement, LaunchVic
• Janey Martino, Founder of Smiling Mind
• Dr Michelle Blanchard, Research Centre Sane Australia
• Addie Wootten, CEO of Smiling Mind
• David Chung, Founder of Limbr and Senior Ventures
Manager at BUPA
• Chris Naoumidis, Founder of Mindset
• Alex Naoumidis, Founder of Mindset
• Rosie Thomas, Founder of Project Rockit
• Lucy Thomas, Founder of Project Rockit
• Christopher Marr, Co-founder and Chief Commercial
Officer of Sonder
• Dr Buzz Palmer, Co-founder and CEO of MedTech
Actuator (RMIT)
• Shol Blustein, ImpactCo
• Cormach Evans, Ngarramili
• Honor Eastly, Big Feels Club
• Rachel Yang, Giant Leap Fund

Roundtable 2 July 2020 Mental health • Katherine Ariola, Project Officer, Koori Youth Justice
services for Taskforce, Commissioner for Aboriginal Children and
children and Young People
young people in • Paris Aristotle, CEO, Foundation House
the youth justice
system • Dr James Belshaw, Melbourne Health
• Megan Boland, Department of Health and Human
Services
• Liana Buchanan, Principal Commissioner for
Children and Young People
• Her Honour Judge Amanda Chambers, President,
Children’s Court of Victoria
• Assistant Commissioner Luke Cornelius APM, Victoria
Police
• Dannii de Kretser, Deputy Secretary, Youth Justice,
Department of Justice and Community Safety
• Dr Adam Deacon, Alfred Health
• Dr Paul Denborough, Clinical Director, Alfred Child
and Youth Mental Health Services and headspace,
Alfred Hospital
• Julie Edwards, CEO, Jesuit Social Services
• Commander Tim Hansen, Victoria Police
• Jodi Henderson, Youth Justice Commissioner,
Department of Justice and Community Safety
• Dan Nicholson, Executive Director, Criminal Law,
Victoria Legal Aid
• Professor James Ogloff AM, Executive Director,
Victorian Institute of Forensic Mental Health
and Distinguished Professor, Centre for Forensic
Behavioural Sciences, Swinburne University
• Joshua Smith, Deputy Secretary, Aboriginal Justice,
Department of Justice and Community Safety

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Engagement Date Title or topic Attendees

Roundtable 7 July 2020 Social • Chelsea Lang, Manager, YLab, Foundation for Young
connectedness Australians
– Effectiveness • Jennifer Beckett, University of Melbourne
of community-
led initiatives • Professor Judy Lowthian, Head of Research and
involving social Principal Research Fellow, Bolton Clarke
connection in • Kerry Jones, Director, Systems Initiatives, The
supporting mental Australian Centre for Social Innovation
wellbeing: A rapid • Jodie Belyea, Founder, Women’s Spirit Project
review of evidence
and practice • Zachary Schlosser, Resilient Connections
• Ian Forsyth, Shannon Company

Roundtable 8 July 2020 Primary care • Dr Cathy Andronis, General Practitioner, Royal
Australian College of General Practitioners
• Caroline Radowksi, Network Director Clinical and
Practice Excellence, community health centre
general practitioner, cohealth
• Sara Renwick-Lau, General Practitioner, Mallacoota
Medical Centre
• Professor Graeme Meadows, Department of
Psychiatry, Monash University,
• Vikki Ryall, Executive Director, Clinical Practice,
headspace
• Margaret McDonald, CEO, Cobaw Community Health
Service
• Joe Fishburn, FirstStep
• Anne Lyon, formerly Eastern Melbourne Primary
Health Network
• Matt Jones, CEO, Murray Primary Health Network

Roundtable 8 July 2020 Crisis response • Karyn Cook, Executive Director, Mental Health
Services, SouthWest Healthcare
• Fran Timmins, Director of Nursing, Mental Health, St
Vincent’s Hospital
• Ivan Frkovic, Commissioner, Queensland Mental
Health Commission
• Dr Aaron Groves, Chief Psychiatrist, Tasmania
• Tracey Morgan, Community Services Manager, Casey
area, Monash Health
• Georgie Harman, CEO, Beyond Blue
• Dr Murray Wright, Chief Psychiatrist, New South
Wales Government
• Susan Murray, Practice Leader, Zero Suicide Institute
of Australasia
• Dr Kathryn Turner, Clinical Director, Mental Health
and Special Services, Gold Coast Hospital and Health
Service
• Peter Kelly, Director, Operations, NorthWestern
Mental Health

Roundtable 8 July 2020 Forensicare • Forensicare Consumer Advisory Group members

Consumer
Advisory Group

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Royal Commission into Victoria’s Mental Health System

Engagement Date Title or topic Attendees

Roundtable 14 July Responding • Caz Healy, Executive Lead Services, cohealth

2020 effectively to • Dr Gerry Naughtin, Strategic Adviser, Mental Health,
consumers Strategic Advisers and Research Division, National
with severe Disability Insurance Agency
and enduring
mental illness • Professor Carol Harvey, Director, Psychosocial
and complex Research Centre, University of Melbourne and
multiagency Consultant Psychiatrist, NorthWestern Mental Health
needs • Professor Lisa Brophy, Professor of Social Work and
Social Policy, La Trobe University
• Dr Neil Coventry, Chief Psychiatrist, Department of
Health and Human Services
• David Clarke, Clinical Director, Monash Health
• Dr David Huppert, Deputy Chief Psychiatrist,
Department of Health and Human Services
• Dr Greta Moon, St Vincent’s Hospital
• Jacinta Pollard, CEO, Caraniche
• Peter Kelly, Director, Operations, NorthWestern
Mental Health
• Shane Beaumont, Manager, Multiple and Complex
Needs Initiative, Department of Health and Human
Services
• Karenza Louis-Smith, CEO, ermha365
• Dr Ravi Bhat, Divisional Clinical Director, Goulburn
Valley Area Mental Health Service, Goulburn Valley
Health
• Associate Professor Sathya Rao, Executive Clinical
Director, Spectrum Personality Disorder Service

Roundtable 15 July Primary health • Janine Wilson, CEO, Eastern Melbourne Primary
2020 networks Health Network
• Adjunct Associcate Professor Christopher Carter,
CEO, North Western Primary Health Network
• Elizabeth Deveny, CEO, South Eastern Melbourne
Primary Health Network
• Rowena Clift, CEO, Western Victorian Primary Health
Network

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Engagement Date Title or topic Attendees

Roundtable 15 July Consultation • Associate Professor Alex Holmes, Psychiatrist, Royal

2020 liaison services Melbourne Hospital
• Professor Steve Ellen, Psychiatrist, Peter MacCallum
Cancer Centre
• Dr David Kissane, Academic Psychiatrist, Monash
University
• Dr Ravi Bhat, Divisional Clinical Director, Goulburn
Valley Area Mental Health Service, Goulburn Valley
Health
• Melody Sutton, Occupational Therapist and
Coordinator Secondary Consultation and
Community Education, Eastern Health Children
Youth Mental Health Service
• Katrina Richardson, Senior Social Worker, Alfred
Children Youth Mental Health Service
• Dr Manoj Kumar, Lead Consultant Psychiatrist, Mercy
Health
• Professor Suresh Sundram, Head, Department of
Psychiatry, School of Clinical Sciences, Monash
University and Director of Research, Mental Health
Program, Monash Health
• Ziver Talat, Senior Social Worker, Royal Children’s
Hospital Child and Adolescent Mental Health Service
Secondary Consultation Service

Roundtable 15 July Finding and • Maureen Lewis, Director, Priority Programs, Mental
2020 accessing care, Health Branch, NSW Health
treatment and • Dr Paul Denborough, Clinical Director, Alfred Child
support and Youth Mental Health Service and headspace,
Alfred Health
• Dr Steven Moylan, Director, Clinical Services, Barwon
Health
• Jason Davies-Kildea, Head, Policy and Advocacy,
Beyond Blue
• Associate Professor Philip Tune, Clinical Director,
Mental Health Services, Bendigo Health
• Bronwyn Lawman, Director, Operations, Peninsula
Health

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Royal Commission into Victoria’s Mental Health System

Engagement Date Title or topic Attendees

Roundtable 21 July Public health • John Batho, Executive Director Fairer Victoria,
2020 Department of Premier and Cabinet
• Dr Bruce Bolam, Executive Director, Health
Protection, Department of Health and Human
Services
• Professor Cathy Mihalopoulos, Chair and Head,
Deakin Health Economics, Deakin University
• Dr Gaynor Blankley, Deputy Clinical Services Director,
Mercy Mental Health and Head of Perinatal Mental
Health
• Carolyn Nikoloski, Chief Strategy Officer, Beyond Blue
• Professor Helen Herrman AO, Head, Vulnerable and
Disengaged Youth Research, Orygen and Professor
of Psychiatry, Centre for Youth Mental Health,
University of Melbourne, President, World Psychiatric
Association
• Kerry Jones, Director Systems Initiatives, The
Australian Centre for Social Innovation
• Professor Patrick McGorry AO, Professor of Youth
Mental Health, University of Melbourne and Executive
Director, Orygen
• Professor Rob Moodie, Nossal Institute of Global
Health, University of Melbourne
• Associate Professor Peter Bragge, Monash
Sustainable Development Institute
• Dr Sandro Demaio, CEO, VicHealth
• Dr Stephen Carbone, Executive Director, Prevention
United
• Thea Snow, Centre for Public Impact, Australia and
New Zealand
• Kristan Corben, Executive Manager, VicHealth

Roundtable 21 July Alcohol and other • Laurence Alvis, CEO, UnitingCare Regen
2020 drugs • Sam Biondo, Executive Officer, Victorian Alcohol and
Drug Association Inc.
• Dr Stefan Gruenert, CEO, Odyssey House
• Ann-Maree Kaser, CEO, Windana
• Gary Croton, Clinical Nurse Consultant, Victorian
Dual Diagnosis Initiative
• Andrew Brunn, CEO, Youth Support and Advocacy
Service (YSAS)
• Professor Dan Lubman, Turning Point
• Professor James Ogloff AM, Executive Director,
Victorian Institute of Forensic Mental Health
and Distinguished Professor, Centre for Forensic
Behavioural Sciences, Swinburne University
• Heather Pickard, CEO, Self Help Addiction Resource
Centre (SHARC)
• Sione Crawford, Harm Reduction Victoria

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Engagement Date Title or topic Attendees

Roundtable 22 July Community • Frances Cook, Director, Vision 2030, National Mental
2020 integrated mental Health Commission
health services • Professor Ian Hickie, Co-Director, Health and Policy,
Brain and Mind Centre, Sydney University
• Kent Burgess, Acting CEO, Star Health
• Professor Richard Newton, Clinical Director, Mental
Health, Peninsula Health
• Brian Kennedy, Director, Community Operations
Adult Mental Health, Albury Wodonga Mental Health
• Dr Sarah Pollock, Executive Director, Research and
Advocacy, Mind Australia
• Tass Mousaferiadis, Chair of the Board and
Chair, Executive Performance and Development
Committee, Star Health
• Laura Collister, Director, Mental Health Services,
Wellways

Roundtable 23 July Infant and child • Professor Frank Oberklaid, Paediatrician, Royal
2020 mental health Children’s Hospital, Melbourne and Co-Group
Leader of Child Health Policy, Equity and Translation,
Murdoch Children’s Research Institute
• Alison Smith, Divisional Manager, Child and Youth
Mental Health, Austin Health
• Dr Richard Haslam, Director, Mental Health, Royal
Children’s Hospital, Melbourne
• Dr Vibhay Raykar, Clinical Director, Child and
Adolescent Mental Health Service, Goulburn Valley
Health
• Dr Louise Newman, Professor of Psychiatry,
University of Melbourne and practising perinatal and
infant clinician
• Allison Cox, Director, Take Two, Berry Street
• Professor Christel Middeldorp, Professor of Child
and Youth Psychiatry, Children and Health Research
Centre Queensland and Queensland’s Child and
Youth Mental Health Service
• Associate Professor Campbell Paul, Consultant Infant
and Child Psychiatrist, Royal Children’s Hospital,
Melbourne; Honorary Principal Fellow, Department
of Psychiatry, University of Melbourne and Member,
Board of Directors, World Association for Infant
Mental Health
• Jacquie O’Brien, CEO, Tweddle
• Helen Lees, Municipal Association of Victoria
Maternal and Child Health Nurse Consultant

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Engagement Date Title or topic Attendees

Roundtable 29 July Community • Professor David Castle, St Vincent’s Health

2020 integrated mental • Frances Cook, Director, Vision 2030, National Mental
health services Health Commission
• Professor Ian Hickie, Co-Director, Health and Policy,
Brain and Mind Centre, Sydney University
• Kent Burgess, Acting CEO Star Health
• Brian Kennedy, Director, Community Operations
Adult Mental Health, Albury Wodonga Mental Health
• Tass Mousaferiadis, Chair of the Board and
Chair, Executive Performance and Development
Committee, Star Health
• Laura Collister, CEO, Wellways
• Dr Sarah Pollock, Executive Director, Research and
Advocacy, Mind Australia

Roundtable 29 July Bed-based • Stefano Scalzo, Director, Victorian Health and Human
2020 services Services Building Authority
• Francis Diver, CEO, Barwon Health
• Professor David Copolov, Monash University
• Cayte Hoppner, Executive Director, Mental Health
and Chief Mental Health Nurse, Latrobe Regional
Hospital
• Professor Nicholas Lintzeris, University of Sydney
• Sebastian Rosenberg, Head, Mental Health Policy
Unit, Centre for Mental Health, Australian National
University
• Sean Hegarty, General Manager, Wellways

Roundtable 30 July Suicide prevention • Dr Jaelea Skehan OAM, Special Adviser, National
2020 and response Suicide Prevention Taskforce
• Jo Robinson, Head, Suicide Prevention
Research Orygen 
• Maureen Lewis, Director, Priority Programs, Mental
Health Branch, NSW Health
• Janet Martin, Director, Clinical Governance,
Queensland Health 
• Alan Woodward, Commissioner, National Mental
Health Commission
• Judge John Cain, State Coroner, Coroners Court of
Victoria
• Professor Jane Pirkis, Director, Centre for Mental
Health, Melbourne School of Population and Global
Health
• Bronwen Edwards, CEO, Roses in the Ocean
• Joe Ball, CEO, Switchboard

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Engagement Date Title or topic Attendees

Roundtable 4 August Australian Health • Martin Fletcher, CEO, Australian Health Practitioner
2020 Practitioner Regulation Agency
Regulation • Dr Peggy Brown AO, Senior Clinical Advisor,
Agency (AHPRA) Australian Commission on Safety and Quality in
Health Care and Member, Agency Management
Committee, Australian Health Practitioner Regulation
Agency
• Associate Professor Ruth Vine, Deputy Chief Medical
Officer for Mental Health, National Mental Health
Commission and Member, Victorian Board of the
Medical Board of Australia
• Dr Debra O’Brien, Chair, Victorian Board of the
Medical Board of Australia
• Dr Rachel Phillips, Chair, Psychology Board of
Australia
• Sally Cunningham, Member, Occupational Therapy
Board of Australia
• Lynette Cusack, Chair, Nursing and Midwifery Board
of Australia
• Renee Owens, Chair, Aboriginal and Torres Strait
Islander Health Practice Board of Australia 
• Dr Clarissa Martin, State Manager, Australian Health
Practitioner Regulation Agency
• Nick Lord, National Director, Government Relations,
Australian Health Practitioner Regulation Agency
• Helen Townley, National Director, Policy, Australian
Health Practitioner Regulation Agency

Roundtable 4 August Youth mental • Professor Patrick McGorry AO, Professor of Youth
2020 health Mental Health, University of Melbourne and Executive
Director, Orygen
• Dr Paul Denborough, Clinical Director, Alfred Child
and Youth Mental Health Service and headspace,
Alfred Health
• Andrew Bruun, CEO, Youth Support and Advocacy
Service (YSAS)
• Jason Trethowan, CEO, headspace
• Dr Leaanne Fisher, Clinical Director, Child and Youth,
Austin Health
• Dr Liam O’Connor, Faculty Chair, Child and
Adolescent Psychiatry, Royal Australian and New
Zealand College of Psychiatry and practising child
and adolescent psychiatrist, Bendigo Child and
Adolescent Mental Health Service
• Dean McCaughan, Services Manager, headspace
• Lynne Allison, Associate Program Director, Child and
Youth Mental Health Service, Eastern Health
• Dr John Cooper, Consultant Psychiatrist, Phoenix
Australia

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Engagement Date Title or topic Attendees

Roundtable 5 August Governance and • Terry Symonds, Deputy Secretary, Health and
2020 commissioning Wellbeing, Department of Health and Human
Services
• Elda Colagrande, Senior Analyst, Service Delivery
and Reform, Department of Treasury and Finance
• Dr Jane Opie, Board Member, Victorian Primary
Health Network
• Bronwyn Lawman, Director, Mental Health
Operations, Peninsula Health
• Kent Burgess, Acting CEO, Star Health
• Ivan Frkovic, Mental Health Commission, Queensland
• Dr Leanne Beagley, CEO, Mental Health Australia
• Dr Ravi Bhat, Divisional Clinical Director, Goulburn
Valley Area Mental Health Service, Goulburn Valley
Health
• Dr Stephen Duckett, Health Program Director,
Grattan Institute
• Professor Hal Swerissen, Visiting Fellow, Grattan
Institute

Roundtable 7 August Aged persons • Gerard Mansour, Commissioner for Senior Victorians 
2020 mental health • Dr Daniel O’Connor, Deputy Chief Psychiatrist (Aged),
services Department of Health and Human Services 
• Dr Brett Coulson, Director, Clinical
Services, NorthWestern Mental Health 
• Dr Maria Tsanglis, Director, Aged and Liaison
Psychiatry Service, Alfred Health 
• Associate Professor Briony Dow, National Ageing
Research Institute 
• Dr Gerry Naughtin, Strategic Adviser, Mental Health,
Strategic Advisers and Research Division, National
Disability Insurance Agency
• Associate Professor Mark Yates, Executive
Director, Ballarat Innovation and Research
Collaboration for Health 
• Mark Silver, Wellbeing Clinic for Older Adults,
Swinburne University

Roundtable 12 Aug Digital fireside • Jennifer Westacott, CEO, Business Council of

2020 chat Australia
Hosted by • Greg Ellis, CEO, MYOB
Jennifer
Westacott, • Ingrid Jenkins, Director, Human Resources, Microsoft
Business Council • Samantha Yorke, Senior Government Affairs and
of Australia Public Policy Manager, Google
• Kara Hinesley, Head, Public Policy, Twitter Australia

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Engagement Date Title or topic Attendees

Roundtable 19 August Workforce needs • Michaela Cronin, Director, Future Social Services
2020 of the future Institute
and enabling • Robyn Mildon, Executive Director, Centre for Evidence
transformation and Implementation
• Professor Chris Davey, Head, Department of
Psychiatry, University of Melbourne
• Dr Tom Foley, National Health Service Digital (UK)
• Gill Callister, CEO, Mind Australia
• Adele Beasley, Manager, Policy and Campaigns, Mind
Australia
• Larry Kamener, Centre for Public Impact, Boston
Consulting Group
• Professor Emeritus Bruce Singh AM, University of
Melbourne
• Dr Rosemary Charleston, Centre for Mental Health
Learning
• Kylie Boucher, Senior Project Lead, Centre for Mental
Health Learning
• Angus Clelland, CEO, Mental Health Victoria
• Associate Professor Bridget Hamilton, Director, Centre
for Psychiatric Nursing, University of Melbourne
• Erandathie Jayakody, Royal Commission into
Victoria’s Mental Health System’s Expert Advisory
Committee and Assistant Director, National Disability
Insurance Agency

Roundtable 25 August Mentally healthy • Chris Wilks, Group Manager, Safety, Health and
2020 workplaces, Wellbeing, Linfox
mentally healthy • Marian Merrigan, Healthy Fox Program Manager,
Victoria Linfox
• Nicci Horton, Injury and Wellbeing Manager, Bunnings
• Kylie Bishop, People and Culture Leader, Medibank
• Chris Akayan, Head, Culture and Capability, Mirvac
• Susan Ferrier, Group Executive, People and Culture,
National Australia Bank Limited
• Jacquie Lyon, Head of Health and Wellbeing , Metro
Trains
• David Brewster, Chief Legal and Safety Officer, Coles
• Angela Konstantopoulos, General Manager, Safety,
Coles
• Sue Davies, Executive General Manager, People and
Culture, Australia Post
• Alex Badenoch, Group Executive, Transformation,
Communications and People, Telstra
• Tanya Hosch, General Manager, Inclusion and Social
Policy, AFL
• Kate Hall, Head, Mental Health and Wellbeing, AFL
• Claire Spencer AM, Chair, Arts Wellbeing Collective
and CEO, Arts Centre Melbourne
• Annie Reeves, Executive Director, People and Culture,
Department of Jobs, Precincts and Regions
• Dr Kate Cornick, CEO, LaunchVic
• Alistair Carmichael, Associate Partner, McKinsey and
Company
• Helen Steele, CEO, The Shared Value Project

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Engagement Date Title or topic Attendees

Roundtable 26 August Governance and • James Downie, CEO, Independent Hospital Pricing
2020 commissioning Authority
• Elda Colagrande, Senior Analyst, Service Delivery
and Reform, Department of Treasury and Finance
• Terry Symonds, Deputy Secretary, Health and
Wellbeing, Department of Health and Human
Services
• Dr Jane Opie, Board Member, Western Victoria
Primary Health Network
• Kent Burgess, Acting CEO, Star Health
• Ivan Frkovic, Mental Health Commission, Queensland
• Dr Leanne Beagley, CEO, Mental Health Australia
• Dr Ravi Bhat, Divisional Clinical Director, Goulburn
Valley Area Mental Health Service, Goulburn Valley
Health
• Professor Hal Swerissen, Visiting Fellow, Grattan
Institute
• Jennifer Williams, Chair, Northern Health
• Abbe Anderson, General Manager, Health Alliance
• Dr Stephen Duckett, Health Program Director,
Grattan Institute

Roundtable 27 August Virtual help and • Oliver Bladek, Deputy CEO, Design, Digital and
2020 the future of Strategy, National Disability Insurance Agency
digital services • Emma Constantine, General Manager, Quality and
Service Development, Wellways
• Rohan Hammet, Director, Deloitte
• Cinnamon Pollard, Chief Experience Officer, Beyond
Blue
• Mario Alvarez-Jimenez, Director, Orygen Digital
• Ramesh Kumar, CEO, Southern Migrant and Refugee
Centre
• Dr Steven Moylan, Director, Clinical Services, Barwon
Health
• Associate Professor Neil Thomas, Deputy Director,
Centre for Mental Health, Swinburne
• Addie Wootten, CEO, Smiling Mind
• Dr Katherine James, Clinical Director, Mildura Base
Hospital
• Dr Kean-Seng Lim, Mount Druitt Medical Centre, New
South Wales

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Roundtable 8 Professional • Dr Cathy Andronis, Chair, Royal Australian College of

September colleges and General Practitioners, Victoria
2020 bodies • Anneka Farrington, Victorian and ACT Branch
Manager, Australian Association of Social Workers
• Grant Coultman-Smith OAM, VA, BJ, JP, Victorian
President, Australasian Institute of Emergency
Services
• Dr Kerryn Rubin, Chair, Royal Australian and New
Zealand College of Psychiatry (Victoria)
• Professor Judy Savige, Chair, Victorian Regional
Committee, Royal Australasian College of Physicians
• Alex Hillman, Mental Health Clinician and
Occupational Therapist, Occupational Therapy
Australia
• Jacqueline White, Victorian State Chair, Australian
Psychological Society

Roundtable 15 East Gippsland • Peter Quinn, Mental Health Clinician, Royal Flying
September Roundtable Doctor Service
2020 Hosted by • Lauren Zappa, Health Services Manager, Royal Flying
Selena Gillham, Doctor Service
Executive Officer, • Kelly Duncan, Department of Education and Training
East Gippsland
Primary Care • Terri McNeil, Lucknow Primary School
Partnership • James Bush, Youth Advisory Group, headspace
• Brydie Bourke, Community Engagement Officer,
headspace
• Matt Zagami, Farmers, Farmers Voice East Gippsland
• Katie Zagami, Farmers, Farmers Voice East
Gippsland
• Jamie Williamson, CEO, Gippsland and East
Gippsland Aboriginal Co-Operative
• Vicki Farthing, CEO, Orbost District Health
• Robyn Hayles, CEO, Bairnsdale Regional Health
• Sue Mulkearns, Manager, Mental Health East
Gippsland, Latrobe Regional Hospital
• Sue Medson OAM, CEO, Gippsland Lakes Complete
Health
• Sarah Clarke, Manager, Regional Services, Gippsland
Primary Health Network
• Jo Grzelinska, Special Projects, Gippsland Primary
Health Network
• Daniel Poynton, Executive Officer, GippSport
• Selena Gillham, Executive Officer, East Gippsland
Primary Care Partnership

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Royal Commission into Victoria’s Mental Health System

Engagement Date Title or topic Attendees

Roundtable 15 Forensic mental • Dr Margaret Grigg, CEO, Forensicare

September health • Professor James Ogloff AM, Executive Director,
2020 Victorian Institute of Forensic Mental Health
and Distinguished Professor, Centre for Forensic
Behavioural Sciences, Swinburne University
• Dr Neil Coventry, Chief Psychiatrist, Department of
Health and Human Services
• Hannah Brown, Acting Director, Justice Health,
Department of Justice and Community Safety
• Associate Professor Ruth Vine, Deputy Chief Medical
Officer for Mental Health, National Mental Health
Commission

Roundtable 16 Youth justice and • Professor James Ogloff AM, Executive Director,
September youth forensic Victorian Institute of Forensic Mental Health
2020 mental health and Distinguished Professor, Centre for Forensic
Behavioural Sciences, Swinburne University
• Professor Andrew Chanen, Director, Clinical
Programs and Services, Orygen Youth Health
• Dr Paul Denborough, Clinical Director, Alfred Child
and Youth Mental Health Service and headspace,
Alfred Health
• Dr Neil Coventry, Chief Psychiatrist, Department of
Health and Human Services
• Dr John Cooper, Consultant Psychiatrist, Bendigo
Child and Adolescent Mental Health Service

Roundtable 22 Regulation and • Claire Noone, Principal, Nous Group

September oversight • Liana Buchanan, Principal Commissioner for
2020 Children and Young People
• Dr Stephen Duckett, Health Program Director,
Grattan Institute
• Renee Cassidy, Assistant Auditor-General
• Melissa Skilbeck, Deputy Secretary, Regulation,
Health Protection and Emergency Management,
Department of Health and Human Services

Roundtable 24 North eastern • David Noonan, CEO, Albury Wodonga Aboriginal

September Victoria Health Service
2020 Hosted by Simone • Lucie Shanahan, Executive Director, Mental Health,
Hogg, Director, Albury Wodonga Health
Community • Karina Kerr, Centre Manager, headspace, Albury
Development, City Wodonga
of Wodonga
• Jacki Eckert, General Manager, Gateway Health
• Dominic Sandilands, CEO, Corryong Health
• Kasey Holyman, Manager, Child, Youth and Families,
Uniting
• Jodie Farrugia, Community Advocacy Officer, Albury
Wodonga Ethnic Communities Council
• Nerida Kerr, CEO, AgBiz Assist
• Simone Hogg, Director, Community Development,
City of Wodonga

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Volume 5 Appendices

Engagement Date Title or topic Attendees

Roundtable 1 October Compulsory • Nino Di Pasquale, Director, Nursing, Mental Health

2020 treatment Services, Barwon Health
• Susanne Birks, Manager, St Kilda Road Clinic, Alfred
Health
• Dr Leeanne Fisher, Clinical Director, Children and
Youth Mental Health Service, Austin Health
• Dr Raju Lakshmana, Director, Psychiatry, Goulburn
Valley Health, Shepparton and Clinical Director,
Perinatal Mental Health, Ramsey Health Care, Mitcham
• Dr Kerryn Rubin, Head, Acute Adult Psychiatry,
Peninsula Health

Roundtable 7 October Trauma • Dr Rob Gordon, Clinical Psychologist and President,

2020 Australasian Confederation of Psychoanalytic
Psychotherapies
• Karen Hogan, Forum Convener, Centres Against
Sexual Assault
• Paris Aristotle, CEO, Foundation House
• Dr David Denborough, Director, Dulwich Centre
• Dr Robyn Miller, CEO, MacKillop Family Services
• Dr John Read, Professor of Clinical Psychology,
University of East London, London, UK
• Patrick Lawrence, CEO, First Step
• Michael Struth, Senior Clinical Lead Mental Health,
Western Victoria, Primary Health Network
• Caroline Radowksi, Network Director, Clinical and
Practice Excellence, cohealth
• Dr Charu Gandhi, Clinical Director, Speciality
Services Directorate, Austin Health
• Associate Professor Harry Minas, Head, Global and
Cultural Mental Health Unit, University of Melbourne

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Royal Commission into Victoria’s Mental Health System

Appendix C.6 Human-centred design activities

The Commission held 53 human-centred design activities over 2019–2020.

Activities undertaken as part of Phase one

Date Attendees/topic focus Location

19 November 2019 Aged 18–65 with experience of mental health services in an Wangaratta
outpatient and/or clinical setting in the last 12 months

19 November 2019 Aged 65+ with experience of geriatric/aged mental health services Wangaratta

20 November 2019 Aged 18–65 with experience of acute mental health services in Frankston
inpatient facilities in the last 12 months (but not currently in an
inpatient facility)

20 November 2019 Aged 65+ with experience of geriatric/aged mental health services Frankston

25 November 2019 Aged 18–65 with experience of mental health services in an Bairnsdale
outpatient and/or clinical setting in the last 12 months

25 November 2019 Aged 18+ with experience caring for people experiencing mental Bairnsdale
illness

26 November 2019 Aged 16–25 with lived experience of child and youth mental health Traralgon
services in the last two years

26 November 2019 Aged 18–65 with experience of acute mental health services in Traralgon
inpatient facilities in the last 12 months (but not currently in an
inpatient facility)

27 November 2019 Aged 18–65 with experience of acute mental health services in Melbourne
inpatient facilities in the last 12 months (but not currently in an
inpatient facility)

29 November 2019 Aged 18–65 with experience of mental illness and alcohol and other Melbourne
drugs (AOD) services

29 November 2019 Aged 18+ with experience of forensic/justice mental health services Melbourne

30 November 2019 Aged 18+ with experience caring for people experiencing mental Melbourne
illness

30 November 2019 Aged 16–25 with experience caring for people experiencing mental Melbourne
illness

10 December 2019 Young people (16–25) with a lived experience of mental illness, Melbourne
including those with caring responsibilities

24 February 2020 Forensicare Consumer Advisory Group Melbourne

26 February 2020 Men over 25 years old with experience of mental illness and recent Melbourne
experience of the justice system

26 February 2020 Young men 16+ years old with experience of mental illness and Melbourne
recent experience of the justice system, including Youth Justice

28 February 2020 Women over 25 years old with experience of mental illness and Melbourne
recent experience of the justice system

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Volume 5 Appendices

Date Attendees/topic focus Location

28 February 2020 Young women 16+ years old with experience of mental illness and Melbourne
recent experience of the justice system, including Youth Justice

12 May 2020 Frontline workers in the allied and community health sector online

13 May 2020 Frontline psychiatrists and clinical psychologists from public and online
private sectors

22 May 2020 Those caring for a young person/people under the age of 12 online
experiencing mental illness

27 May 2020 Carers who identify as LGBTIQ+ caring for a person/people online
experiencing mental illness

2 June 2020 Frontline nurses online

3 June 2020 Carers who identify as culturally and linguistically diverse caring online
for a person/people experiencing mental illness

4 June 2020 Young people over 16 and under 25 years old caring for a person/ online
people experiencing mental illness

9 June 2020 Consumer and carer lived experience and peer workers online

Activities undertaken as part of Phase two

Date Attendees/topic focus Location

30 June 2020 Carers who have recent experience of crisis responses online

30 June 2020 People who have recent experience of crisis responses online

6 July 2020 Carers and consumers who have tried to access services across the online
spectrum

7 July 2020 People who have lived experience of both AOD service use and online
mental illness

7 July 2020 Carers of people who have lived experience of both AOD service use online
and mental illness

10 July 2020 People with lived experience of suicidal crisis including carers online

10 July 2020 People with lived experience of bereavement by suicide online

13 July 2020 Carers of adults (18+) with experiences of community-based services online

13 July 2020 Adults (18+) with experiences of community-based area mental online
health services, community health organisations and Primary Health
Network services

17 July 2020 People that have experienced mental illness and housing challenges online
or homelessness

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Royal Commission into Victoria’s Mental Health System

Date Attendees/topic focus Location

20 July 2020 Carers of people with experiences of community-based area mental online
health services, community health organisations and Primary Health
Network services

27 July 2020 People who have had a recent experience in an adult community or online
hospital bed-based setting

27 July 2020 Carers of people who have had a recent experience in an adult online
community or hospital bed-based setting

3 August 2020 Consumers who wish to discuss information sharing, including the online
pros and cons of using technology to support moving between
services, timely support and choices about when/what information is
shared

4 August 2020 Carers who wish to discuss information sharing, including the pros online
and cons of using technology to support moving between services,
timely support and choices about when/what information is shared

5 August 2020 Young consumers aged 16+ with experience of mental health services online

7 August 2020 Those caring for a young person/people under the age of 12 online
experiencing mental illness

7 August 2020 Those caring for a young person/people between 12 and 25 online
experiencing mental illness

3 September 2020 Those who identify as being culturally and linguistically diverse who online
have experience with the mental health system

4 September 2020 Restrictive practices with lived experience experts, including carers online
to develop questions for the combined session

4 September 2020 Restrictive practices with lived experience experts, carers and online
clinicians

10 September 2020 Restrictive practices lived experience experts including carers online

14 September 2020 Speaking From Experience Group, Independent Mental Health online
Advocacy

15 September 2020 Speaking From Experience Group, Independent Mental Health online
Advocacy

6 October 2020 Community workshop with a range of community members in North online
Eastern Victoria

7 October 2020 Community workshop with a range of community members in online

Southern Metropolitan Melbourne

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Volume 5 Appendices

Appendix C.7 Consumer Foundations Working Group members

In July 2020, the Commission established the Consumer Foundations Working Group which
comprised seven members who together brought a range of skills, expertise, experiences
and perspectives to their work. Working Group members provided advice on reforms related
to consumer leadership, with a view to creating an enduring foundation for a future mental
health system that is grounded in consumer expertise.

The members of Commission’s Consumer Foundations Working Group were:

• Cath Roper
• Erandathie Jayakody
• Gareth Edwards
• Heather Pickard
• Ian Watts
• Indigo Daya
• Dr Tricia Szirom

The group was facilitated by Sarah Jane Haywood.

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Royal Commission into Victoria’s Mental Health System

Appendix C.8 The Commission’s

expert systems advisory function
This appendix provides an overview of the systems design advice provided to support the
Commission’s system design approach.

The Commission established an expert systems advisory function in November 2019. The
advisory function had a flexible membership to reflect the specific needs of each stage of the
Commission’s inquiry. It included diverse expertise in systems reform from across Australia
and overseas.

The following people supported the Commission through this function:

• Professor Luis Salvador-Carulla, Head, Centre for Mental Health Research, Research
School of Population Health, College of Health and Medicine, Australian National
University, Canberra
• Professor Richie Poulton, Co-Director, National Centre for Lifecourse Research,
University of Otago, New Zealand
• Ms Allison Costello, Director, Policy and Innovations Branch, Ontario Ministry of Health
and Long-Term Care, Canada
• Dr Robyn Mildon, Founding Executive Director, Centre for Evidence and
Implementation, Melbourne
• Professor Iven Mareels, Chair of Electrical and Electronic Engineering, Electrical and
Electronic Engineering, Melbourne University
• Professor Ezekiel Emanuel, Vice Provost for Global Initiatives, University of
Pennsylvania, United States.

They contributed to the Commission but were in no way associated with its final deliberations
and findings.

The Commission’s system design approach was also informed by Professor Rod Glover and
the team at Monash Sustainable Development Institute.

The Commission also acknowledges Dr Seanna Davidson, Director, The Systems School and
Dr Fiona McKenzie, Director, Orange Compass, who provided content drafting support for the
systems design chapter of this report.

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Volume 5 Appendices

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Royal Commission into Victoria’s Mental Health System

Glossary
The Commission notes that several of the terms within this glossary differ from phrasing used
in its letters patent. Where this is the case, the Commission has either made a deliberate
choice to provide greater clarity on a term, or to enable a more inclusive interpretation. The
Commission has inquired into all matters as per the expectations set in the letters patent.

Term Description

Aboriginal A primary health care service initiated and operated by the local
community Aboriginal community to deliver holistic, comprehensive and culturally
controlled health appropriate health services to the community that controls it, through a
organisation locally elected board of management. This definition is consistent with
that stated by the National Aboriginal Community Controlled Health
Organisation.1

Aboriginal We recognise the diversity of Aboriginal people living throughout

people Victoria. While the terms ‘Koorie’ or ‘Koori’ are commonly used to
describe Aboriginal people of south-east Australia, we have used the
term ‘Aboriginal’ in this report to include all people of Aboriginal and
Torres Strait Islander descent who are living in Victoria. This approach is
consistent with the language conventions of key Victorian frameworks
such as the Aboriginal Affairs Framework 2018–2023.2

Activity-based While similar to a fee-for-service funding model, an activity-based

funding funding model distributes funding to providers for the number of times
they provide services to a person, with the amount based on each
person’s individual needs.3

Acute mental Acute mental health beds, or acute inpatient units, support people
health inpatient experiencing an acute episode of mental illness that calls for treatment
services in hospital. These services include acute mental health beds for young
people, adults and older adults.

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Term Description

Adult and Older Future services that will provide tertiary-level, high-intensity and complex
Adult Area support responses via multidisciplinary teams to people aged 26 years or
Mental Health older in both community and bed based settings.
and Wellbeing
Services Adult and Older Adult Area Mental Health and Wellbeing Services will
deliver all the core functions of community-based mental health services
for those requiring a higher intensity of treatment, care and support than
can be provided through local services.

Services will be delivered through a partnership between a public health

service or public hospital and a non-government organisation that
delivers wellbeing supports (currently known as psychosocial supports).
Access to these services will require a referral from a medical practitioner
or Local Mental Health and Wellbeing Service.

Adult and older Future system that will provide treatment, care and support to Victorians
adult community over the age of 26 years. The Commission has taken an expansive view
mental health of what makes up the community mental health and wellbeing system,
and wellbeing beyond mental health and wellbeing services. The system can be
system considered to span six levels, where the top level engages with the most
people and each subsequent level supports a decreasing proportion of
the population. The six levels are:

• families, carers and supporters, informal supports, virtual

communities and communities of place, identity and interest
• a broad range of government and community services
• primary and secondary mental health and related services
• Adult and Older Adult Local Mental Health and Wellbeing Services
• Adult and Older Adult Area Mental Health and Wellbeing Services
• statewide services.

Within this system, there will be an older adult mental health and
wellbeing service stream that provides treatment, care and support for
people with complex and compounding mental health needs generally
related to ageing who are over the age of 65.

Adult and Older Future services that will deliver treatment, care and support to people
Adult Local aged 26 years or older. They will be delivered in a variety of settings
Mental Health where people first access services and receive most of their treatment,
and Wellbeing care and support. People will access these services either directly or
Services via referral, and services will operate with extended hours. Services will
deliver the Commission’s recommended core functions for community
mental health and wellbeing services. Service delivery may involve Area
Mental Health and Wellbeing Services.

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Royal Commission into Victoria’s Mental Health System

Term Description

Area Mental Future services that will provide tertiary-level, high-intensity and complex
Health and support responses via multidisciplinary teams in both community and
Wellbeing bed based settings. Area Mental Health and Wellbeing Services will
Services deliver all the core functions of community-based mental health services
for those requiring a higher intensity of treatment, care and support than
can be provided through local services or in partnership with them.

Services will be delivered through a partnership between a public health

service and a non-government organisation that delivers wellbeing
supports.

There will be separate Area Mental Health and Wellbeing Services for
infants, children and young people and for adults and older adults. For
infants, children and young people there will be two service streams:
Infant, Child and Family Area Mental Health and Wellbeing Services (0–11);
and Youth Area Mental Health and Wellbeing Services (12–25). There will
also be Adult and Older Adult Area Mental Health and Wellbeing Services
(for people over the age of 26).

Area mental The current state-funded area mental health services provide clinical
health services community-based and inpatient care. Seventeen of Victoria’s public
health services operate area mental health services.

Note: For the purposes of clarity, the current system is referred to in lower
case and elements of the new service system have been capitalised in
this report.

Allied mental A service delivered by a diverse workforce such as psychologists, social

health service workers and occupational therapists, working in a range of public,
private, community and primary care settings.

Ambulatory care Care provided to hospital patients who are not admitted to the hospital,
such as patients of emergency departments and outpatient clinics. The
term also refers to care provided to patients of community-based (non-
hospital) healthcare services.4

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Volume 5 Glossary

Term Description

Assertive A term applying to a broad range of models of care delivered in different

outreach service contexts. Generally, assertive outreach recognises that some
people may require services to be more proactive in engaging or
following up with them.

Traditionally, assertive outreach models have included low caseloads,

a multidisciplinary team, availability outside business hours, team
autonomy and psychiatrist input.

A variety of assertive outreach models are now in operation in Australia

and internationally.

Assessment An order made under the Mental Health Act 2014 (Vic) that authorises
Order a person to be compulsorily examined by an authorised psychiatrist to
determine whether the treatment criteria, specified in the Mental Health
Act, apply to the person. The order can either be an Inpatient Assessment
Order or a Community Assessment Order, which reflects the location of
where the examination is to occur.5

Authorised A psychiatrist appointed by a designated mental health service to

psychiatrist exercise the functions, powers and duties conferred on this position
under the Mental Health Act 2014 (Vic), the Crimes (Mental Impairment
and Unfitness to be Tried) Act 1997 (Vic) or any other Act.6

Blended care Providing care through integrating digital and face-to-face supports.
In blended care, digital supports are used to complement face-to-face
services and to build on the gains achieved in face-to-face delivery.7

Capitation Under a capitation payment model, providers receive a fixed amount of

funding funding for each person who registers with them for a specified period,
usually a year.8 Capitation funding is similar to block funding; however,
the funding is based on the number and mix of people who are registered
with the service.

Care The provision of ongoing support, assistance or personal care to

another person.9

Carer A person, including a person under the age of 18 years, who provides care
to another person with whom they are in a relationship of care.10

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Royal Commission into Victoria’s Mental Health System

Term Description

Clinical ‘[T]he systems and processes that health services need to have in place
governance to be accountable to the community for ensuring that care is safe,
effective, patient-centred and continuously improving’.11

Coercion The action or practice of persuading in a way that uses or implies force
and threats—forcing someone to do something.

Commissioning While there is no single agreed definition, commissioning can be

understood as a cycle that involves planning the service system,
designing services, selecting, overseeing and engaging with providers,
managing contracts and undertaking ongoing monitoring, evaluation
and improvement.12

Co-commissioning or joint commissioning refers to the ways in which

organisations work together and with their communities to make the
best use of limited resources in the design and delivery of services and to
improve outcomes.13

Community care A unit that provides clinical care and rehabilitation services in a homelike
unit environment.

Community Services that provide primary health, human services and community-
health services based supports to meet local community needs.
and integrated
care services

Community Services provided outside a hospital setting—in community settings

mental health such as clinics or centres, in people’s homes or other places, or delivered
and wellbeing by phone or videoconferencing, or online.14 Community mental health
services and wellbeing services delivered by hospitals are sometimes referred
to as ‘community ambulatory services’ and include care delivered by
hospitals, but not always in the hospital itself, such as through outpatient
or day clinics.15

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Term Description

Community The core functions are recommended by the Commission to ensure

mental health consistency in treatment, care and support delivered across Victoria.
and wellbeing The core functions, which are common across all age ranges, are:
services core
functions • integrated treatment, care and support proportionate to
consumers’ needs, consisting of:

– treatment and therapies—including a broad range of

psychological and psychiatric therapies, other therapeutic
interventions, support for physical health, and support for
substance use or addiction
– wellbeing supports—including supports for community
connection and social wellbeing, building life skills, securing
and maintaining housing, and education, training and
employment supports
– education, peer support and self-help—through education, peer
self-help and guided self-help
– care planning and coordination—to ensure that treatment,
care and support is proportionate to needs and to provide
continuity of care

• services to help people find and access treatment, care and

support and in Area Mental Health and Wellbeing Services to
respond 24 hours a day, seven days a week to people experiencing
a mental health crisis
• support for primary and secondary services (for example, GPs),
including primary and secondary consultation and comprehensive
shared care.

Comorbidity A situation where a person has two or more health problems at the same
time. Also known as multimorbidity.

Compulsory Under section 3 of the Mental Health Act 2014 (Vic) a compulsory
patient patient means a person who is subject to an Assessment Order, Court
Assessment Order, Temporary Treatment Order or Treatment Order
under the Act. Compulsory patients are sometimes referred to as
‘involuntary patients’.

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Royal Commission into Victoria’s Mental Health System

Term Description

Compulsory The treatment of a person for mental illness subject to an order under
treatment the Mental Health Act 2014 (Vic), the Crimes (Mental Impairment
and Unfitness to be Tried) Act 1997 (Vic) or the Sentencing Act 1991
(Vic). This can include the administration of medication, hospital
stays, electroconvulsive treatment or neurosurgery for mental illness.
Compulsory treatment is sometimes referred to as ‘involuntary
treatment’.

Consecutive When a person is placed on a new compulsory treatment order, in

order anticipation of the current order ending,16 to create a continuous duration
and includes an Assessment Order, a Temporary Treatment Order and a
Treatment Order.

Consumer People who identify as having a living or lived experience of mental illness
or psychological distress, irrespective of whether they have a formal
diagnosis, have used mental health services and/or received treatment,
care or support.

Consumer- These measures collect information on the effectiveness of mental health

completed and wellbeing services directly from the people who access services.
measures and They are a direct measure of experiences or outcomes, as determined by
family-, carer- the individual. This information can be collected using a range of tools
and supporter- including questionnaires or standardised surveys.17
completed
measures

Consumer The Commission uses the streams to describe how, at any given point in
streams time, a person experiencing mental illness or psychological distress will
need one of:

• support from their communities and primary care services

(communities and primary care stream)
• treatment, care and support from primary and secondary mental
health and related services (primary care with extra supports stream)
• short-term treatment, care and support from a Local Mental Health
and Wellbeing Service or an Area Mental Health and Wellbeing
Service (short-term treatment, care and support stream)
• ongoing treatment, care and support from a Local Mental Health
and Wellbeing Service or an Area Mental Health and Wellbeing
Service (ongoing treatment, care and support stream)
• ongoing intensive treatment, care and support from a Local Mental
Health and Wellbeing Service or an Area Mental Health and Wellbeing
Service (ongoing intensive treatment, care and support stream).

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Volume 5 Glossary

Term Description

Co-production This involves people with lived experience of mental illness or

psychological distress leading or partnering across all aspects of an
initiative or program from the outset—that is, co-planning, co-designing,
co-delivering and co-evaluating.18

Cultural safety An environment that is safe for people—where there is no assault,

challenge or denial of their identity, of who they are and what they need.
It is about shared respect, shared meaning, shared knowledge and
experience of learning, living and working together with dignity and truly
listening.

Culturally ‘An approach to policy, intervention, service delivery and intergroup

appropriate interaction that is based on the positive acceptance of the cultural values
and expectations of Aboriginal people.’19 Culturally appropriate care is
important for people from a broad range of cultures.

Culturally Term used in this report to reflect the fact that the Victorian population is
diverse diverse and that culture and language can influence people’s needs and
their access to mental health services that meet their needs.

Designated A health service20 that is prescribed in the Mental Health Regulations 2014
mental health (Vic) to provide compulsory treatment21 (includes Forensicare).
service

Digital The use of online and other digital technologies to improve mental
mental health health and wellbeing, including access to information, service delivery,
technology education, promotion and prevention.

It encompasses a vast range of technologies including apps, portals,

social media, smartphones, augmented or virtual reality, wearables,
activity tracking, e-referral, notifications and artificial intelligence. Other
common terminology includes ‘e-mental health’ (health services that are
online), ‘m-health’ (mobile and app-based support) and ‘virtual health’.22

This report uses ‘digital mental health technology’ as an overarching

term that encompasses many types of technology. Where relevant,
however, the report names specific technologies.

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Royal Commission into Victoria’s Mental Health System

Term Description

Discrimination At its most basic, discrimination refers to the prejudicial treatment of

people based on their individual or collective characteristics.

In Victoria, the Equal Opportunity Act 2010 (Vic) makes it unlawful to

discriminate on the basis of ‘disability’ (which is defined to include
a ‘mental or psychological disease or disorder’)23 in certain settings
including health care, employment and schools. This can be through
‘direct discrimination’ such as when someone is treated unfavourably
because of a personal characteristic like mental illness.24 This could be
a refusal to treat someone, provide them access to services or admit
them to a school because they have a mental health diagnosis. The law
also protects against ‘indirect discrimination’, where an unreasonable
requirement, condition or practice disadvantages a person or group of
people based on a characteristic.25

Dual diagnosis Term historically used to describe services in Victoria that provide
service treatment, care and support to consumers living with mental illness and
substance use or addition.

Dual disability Term defined in the Commission’s interim report as people living with
both mental illness and an acquired or neurodevelopmental disability
(such an intellectual disability, autism spectrum disorder, attention-
deficit/hyperactivity disorder or a communication disorder).26

Early Includes prevention and early treatment. Early intervention can involve
intervention equipping people to deal with the signs and symptoms of illness or
distress and helping people as soon as possible once mental distress
is identified in order to improve the prospect of recovery (for example,
following exposure to trauma).

Electroconvulsive The ‘application of electric current to specific areas of a person’s head to

treatment produce a generalised seizure’.27 Also known as electroconvulsive therapy.

Enrolment Refers to a consumer voluntarily enrolling with a service provider who is

responsible for coordinating their comprehensive care. The consumer is
free to get care through this ‘responsible’ provider, or through alternative
providers.

Enrolment may or may not be associated with a ‘capitated’ payment

that is linked to the number of consumers enrolled (refer to definition:
‘Capitation funding’).

Family May refer to family of origin and/or family of choice.

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Term Description

Fee for service Under a fee-for-service funding model, service providers receive funding
based on the number and mix of procedures, treatments and services
they deliver.28

Forensic mental A service that provides treatment, care and support services to people
health service living with mental illness who have come into contact with the criminal
justice system.

Forensic patient A person under the Crimes (Mental Impairment and Unfitness to be Tried)
Act 1997 (Vic) through an order of a court and detained at a designated
mental health service (usually at Forensicare’s Thomas Embling Hospital).29

Good mental A state of wellbeing in which a person realises their own abilities, can
health cope with the normal stresses of life, can work productively and is able to
make a contribution to their community.

Harm A health policy approach that recognises there are complex and
minimisation interrelated health, social and economic consequences of substance use
or addiction that affect individuals, families and the community. A harm
minimisation approach recognises that drug use is individual and occurs
from occasional use to dependency. The approach does not condone
drug use but recognises a range of strategies are required to support a
progressive reduction in substance-related harm.

A harm minimisation approach is based on three pillars:

• Harm reduction aims to reduce high-risk behaviours associated

with substance use and providing safer settings such as
smoke‑free areas or free water at music festivals.
• Demand reduction is about preventing uptake of substances.
Demand reduction also involves helping people who use
substances to recover through a range of evidence-based care,
treatment and support options.
• Supply reduction is about controlling the supply and availability of
substances.

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Royal Commission into Victoria’s Mental Health System

Term Description

Indicators Qualitative or quantitative measures that can help determine change or

progress and can be used to determine whether short-, medium- or long-
term outcomes are being achieved. When indicators are used to measure
the outcomes of a particular program or intervention (for example,
resulting from reforms) they are measured from a baseline (before the
program or intervention), at regular intervals after the intervention starts,
and at the end.30

Infant, Child and Future local mental health and wellbeing services for people aged 0–11
Family Health years that will take the form of Infant, Child and Family Health and
and Wellbeing Wellbeing Hubs.
Hubs
These hubs will take a one-stop shop approach to child health by
prioritising infants and children with emotional (for example, mental
health challenges), developmental (for example, intellectual disability,
autism spectrum disorder, speech delay) and physical health challenges
(for example, asthma, allergies, chronic disease) that have continued to
affect their wellbeing despite previous support.

The hubs will provide age-appropriate treatment, care and support, use
a whole-of-family approach, conduct a range of assessments as needed
and be supported by Infant, Child and Family Area Mental Health and
Wellbeing Services.

Infant, Child Future services that will provide tertiary-level, high-intensity and complex
and Family Area support responses via multidisciplinary teams to people aged 0–11 years.
Mental Health Infant, Child and Family Area Mental Health and Wellbeing Services
and Wellbeing are a service stream of the 13 Infant, Child and Youth Area Mental
Services Health Services.

These services will deliver all the core functions of community-based

mental health services for those requiring a higher intensity of treatment,
care and support than can be provided through local services or in
partnership with them.

Infant, Child and Youth Area Mental Health Services will be delivered
through a partnership between a public health service (or public hospital)
and a non-government organisation that delivers wellbeing supports.

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Term Description

Infant, child and Future service stream that will provide treatment, care and support to
family mental Victorians under the age of 12 years. It is one service stream within the
health and broader infant, child and youth mental health and wellbeing system.
wellbeing service
stream The Commission has taken an expansive view of what makes up this
service stream, beyond mental health and wellbeing services. The service
stream can be considered to span six levels, where the top level engages
with the most people and each subsequent level supports a decreasing
proportion of the population. The six levels are:

• families, carers and supporters, informal supports, virtual

communities and communities of place, identity and interest
• a broad range of government and community services
• primary and secondary mental health and related services
• Infant, Child and Family Local Health and Wellbeing Services
• Infant, Child and Family Area Mental Health and Wellbeing Services
within Infant, Child and Youth Area Mental Health Services
• statewide services.

Infant, Child Future services that will provide tertiary-level, high-intensity and complex
and Youth Area support responses via multidisciplinary teams to people aged 0–25 years
Mental Health in both community and bed based settings.
and Wellbeing
Services The 13 Infant, Child and Youth Area Mental Health and Wellbeing Services
will deliver all the core functions of community-based mental health
services for those requiring a higher intensity of treatment, care and
support than can be provided through local services.

Within these services will be two service streams: Infant, Child and Family
Area Mental Health and Wellbeing Services and Youth Area Mental Health
and Wellbeing Services.

Services will be delivered through a partnership between a public health

service or public hospital and a non-government organisation that
delivers wellbeing supports (currently known as psychosocial supports).
Access to these services will require a referral from a medical practitioner
or Local Mental Health and Wellbeing Service.

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Royal Commission into Victoria’s Mental Health System

Term Description

Infant, child and Future health system that will provide treatment, care and support to
youth mental Victorians aged 0–25 years.
health and
wellbeing system Within this broad system, there are two service streams—the infant, child
and family mental health and wellbeing service stream for people aged
0–11 years and the youth mental health and wellbeing service stream for
people aged 12–25 years.

At the area level, there will be shared clinical governance across the age
range of 0–25 years through the 13 Infant, Child and Youth Area Mental
Health Services.

Information ‘Information collection’ refers to mental health information a service

collection, use provider or entity may collect as part of its organisational functions. ‘Use’
and sharing refers to the use of information for the purpose of delivering services
to consumers, or for directly related purposes, such as administration.
‘Use’ also refers to who can see and use this information, and in what
circumstances. It includes the protections and securities put in place to
ensure privacy standards are met. ‘Information sharing’ broadly refers to
the disclosure of information to another worker, provider, organisation or
person for the purposes of treatment, support or accountability.

Inpatient Relating to an admission to an inpatient unit of a designated mental

health service.

Integrated care A service that provides a range of services and supports, including
service primary care and mental health care.

Intersectionality Drawing on the Victorian Government’s 2019 Everybody Matters: Inclusion

and Equity Statement, the Commission describes intersectionality as
a theoretical approach that understands the interconnected nature of
social categorisations—such as gender, sexual orientation, ethnicity,
language, religion, class, socioeconomic status, gender identity, ability
or age—which create overlapping and interdependent systems of
discrimination or disadvantage for either an individual or group.31

Lived experience People with lived experience identify either as someone who is living with
(or has lived with) mental illness or psychological distress, or someone
who is caring for or otherwise supporting (or has cared for or otherwise
supported) a person who is living with (or has lived with) mental illness
or psychological distress. People with lived experience are sometimes
referred to as ‘consumers’ or ‘carers’. The Commission acknowledges that
the experiences of consumers and carers are different.

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Term Description

Lived experience A broad term to represent two distinct professional groups in roles
workforces focused on their lived expertise—people with personal lived experience of
mental illness (‘consumers’) and families and carers with lived experience
of supporting a family member or friend who has experienced or is
experiencing mental illness. Within each professional discipline there are
various paid roles, among them workers who provide support directly
to consumers, families and carers through peer support or advocacy, or
indirectly through leadership, consultation, system advocacy, education,
training or research.

Local Mental Future services that will provide treatment, care and support in a variety
Health and of settings where people first access services. People will access these
Wellbeing services either directly or via referral, and services will operate with
Services extended hours. Services will deliver the Commission’s recommended core
functions. Service delivery may occur in partnership with area services.

These services will be a combination of primary and secondary

responses supported by some tertiary-level responses.

There will be separate local services for each of three age groups: Infant,
Child and Family Local Health and Wellbeing Services (0–11), Youth Local
Mental Health and Wellbeing Services (12–25) and Adult and Older Adult
Local Mental Health and Wellbeing Services (over 26).

Medicare- Service in which the Medicare Benefits Scheme and the associated Better
subsidised Access Initiative provide subsidised access to GPs and other health
mental health- professionals such as psychiatrists, psychologists and other allied health
specific service practitioners.

Mental health An optimal state of mental health, including as it relates to people with
and wellbeing lived experience of mental illness or psychological distress. It can also be
used to refer to the prevention, avoidance or absence of mental illness or
psychological distress.

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Royal Commission into Victoria’s Mental Health System

Term Description

Mental Health A new independent statutory authority recommended by the Royal

and Wellbeing Commission to:
Commission
• hold government to account for the performance and quality and
safety of the mental health and wellbeing system
• support people living with mental illness or psychological distress,
families, carers and supporters to lead and partner in the
improvement of the system
• monitor the Victorian Government’s progress in implementing the
Royal Commission’s recommendations
• address stigma related to mental health.

Mental health Information or an opinion about a consumer’s physical, mental or

and wellbeing psychological health, a health service provided, a consumer’s expressed
information wishes about future service delivery, and personal information collected
to provide health services. Information from others, including families,
carers and supporters may also be included in mental health information,
where appropriate.

Mental health The Commission outlines in this report its vision for a future mental
and wellbeing health and wellbeing system for Victoria. Mental health and wellbeing
system does not refer simply to the absence of mental illness but to creating the
conditions in which people are supported to achieve their potential. As
part of this approach, the Commission has also purposefully chosen to
focus on the strengths and needs that contribute to people’s wellbeing.
To better reflect international evidence about the need to strike a
balance between hospital-based services and care in the community,
the types of treatment, care and support the future system offers will
need to evolve and be organised differently to provide each person with
dependable access to mental health services and links to other supports
they may seek. The addition of the concept of ‘wellbeing’ represents a
fundamental shift in the role and structure of the system.

Mental health Overarching term that takes in services (with various funders and
system providers) that have a primary function of providing treatment, care or
support to people living with mental illness and/or their carers. This term
is used to describe the current and historical system.

Mental Health Independent statutory tribunal established under the Mental Health Act
Tribunal 2014 (Vic) to hear and determine the making of Treatment Orders and
other applications, including applications to perform electroconvulsive
treatment when a person does not have decision-making capacity or is
under the age of 18 years and applications to perform neurosurgery for
mental illness.32

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Term Description

Mental illness A medical condition that is characterised by a significant disturbance of

thought, mood, perception or memory.33

The Commission uses the above definition of mental illness in line with
the Mental Health Act 2014 (Vic). However, the Commission recognises
the Victorian Mental Illness Awareness Council Declaration released on 1
November 2019.

The declaration notes that people with lived experience can have varying
ways of understanding the experiences that are often called ‘mental
illness’.

It acknowledges that mental illness can be described using terms such

as ‘neurodiversity’, ‘emotional distress’, ‘trauma’ and ‘mental health
challenges’.

Mental wellbeing A dynamic state of complete physical, mental, social and spiritual
wellbeing in which a person can develop to their potential, cope with the
normal stresses of life, work productively and creatively, build strong and
positive relationships with others and contribute to their community.

Neurosurgery for Any of the following three procedures, provided to treat a person meeting
mental illness the criteria for mental illness:

a) ‘any surgical technique or procedure by which one or more

lesions are created in a person’s brain on the same or on separate
occasions for the purpose of treatment
b) the use of intracerebral electrodes to create one or more lesions
in a person’s brain on the same or on separate occasions for the
purpose of treatment
c) the use of intracerebral electrodes to cause stimulation through
the electrodes on the same or on separate occasions without
creating a lesion in the person’s brain for the purpose of
treatment’.34

Nominated The formal nomination of a person under the Mental Health Act
person 2014 (Vic) by a person to provide them with support and help and to
represent their interests and rights at times when they are at risk of
receiving compulsory treatment or are receiving compulsory treatment.
The nominated person also receives information from the authorised
psychiatrist at certain points and is consulted as part of decision-making
processes under the Act.35

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Royal Commission into Victoria’s Mental Health System

Term Description

Older adult Future service stream that will provide treatment, care and support to
mental health Victorians with mental health support needs generally related to ageing.
and wellbeing It is a service stream within the broader adult and older adult mental
service stream health and wellbeing system.

The Commission has taken an expansive view of what makes up this

service stream, beyond mental health and wellbeing services. The service
stream can be considered to span six levels, where the top level engages
with the most people and each subsequent level supports a decreasing
proportion of the population. The six levels are:

• families, carers and supporters, informal supports, virtual

communities and communities of place, identity and interest
• a broad range of government and community services
• primary and secondary mental health and related services
• Adult and Older Adult Local Mental Health and Wellbeing Services
• Adult and Older Adult Area Mental Health and Wellbeing Services,
which will include older adult mental health and wellbeing
specialist multidisciplinary teams
• statewide services.

Outcome Categories or groups of outcomes relating to broad areas of mental

domains health and wellbeing. For example, outcome domains could relate to
providing safe and high-quality mental health services or could relate to
consumer satisfaction with service delivery and treatment and care.

Outcomes Changes to the health or wellbeing of a person, group or population

that results from some kind of intervention or multiple interventions.
Interventions are defined very broadly and include particular models
of care or treatment or making health services more accessible or
acceptable to consumers.36 Individual health outcomes are measures
of individual health and wellbeing status. These can be measured in the
short, medium and long term. Population-level outcomes are measures
of aggregated data on the health of a population—for example, the
population of Victoria or Australia.37 Outcomes are measured using
indicators.

Output funding The Victorian Government uses an ‘output funding model’ whereby
model departments use the investment allocated in the budget process
to deliver on the government’s objectives38 and outputs.39 Output
performance measures are used to specify the expected performance
standard at which these services are to be delivered,40 covering measures
such as the quantity of services provided, timeliness, quality and cost.41

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Term Description

Postvention A range of support services provided to people who have been bereaved
bereavement by suicide.
support

Prevention and Generally a short-term service (up to 28 days) that provides recovery-
recovery care focused treatment in a community-based residential setting.
unit

Primary care Health services where consumers access care, treatment and support
without the need for a referral or without needing to meet certain
eligibility criteria. Primary care settings include general practices,
community health services and some allied health services. Primary
care services are widely distributed, are the most accessible form of
health care and are provided in most local communities across Victoria.
Typical primary care providers are GPs or allied health professionals
such as social workers or mental health nurses. However, primary care
can be offered by a wide range of professionals including psychologists,
paediatricians and maternal child and health workers.

Primary A consultation between a mental health clinician or multidisciplinary

consultation mental health team and a consumer that may be conducted in person
or through teleconferencing or phone. A primary consultation can occur
following a referral—for example, where a GP makes a referral for a
consumer to have a primary consultation with a psychiatrist.

Primary Health Networks that commission a variety of mental health, alcohol and
Networks drug, and suicide prevention services. Services commissioned can vary
but may include: referral and support services; primary and specialist
consultation services; prevention and early intervention services; services
to reduce the harm associated with alcohol and other drugs; and
capacity-building activities such as workforce education and training.42
Refer to Box 29.4 in Chapter 29: Encouraging partnerships for detail.

Primary Strategies that aim to stop the onset of a health condition or disease
prevention from ever occurring by addressing the underlying causes or determinants
of that condition. Primary prevention is distinct from secondary
prevention, also referred to as early intervention, which aims to minimise
the progress of a condition or disease at an early stage. It is also distinct
from tertiary prevention, which aims to stop further progression of the
condition and address the impacts that have already occurred.

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Royal Commission into Victoria’s Mental Health System

Term Description

Private hospital Includes acute care and psychiatric hospitals, as well as private
freestanding hospitals that provide day-only services.

Professional Refers to a formal professional relationship between two mental health

practice practitioners that is designed to enable reflective practice, support
supervision professional self-care, maintain standards of professional practice, refine
relational and clinical competencies and explore ethical issues. It is
distinct from line management and performance management and is not
a form of therapy.

Psychiatric A unit that offers assessment and treatment for people experiencing
assessment and an acute episode of mental illness and that minimises the need for an
planning unit extended hospital stay in an inpatient unit.

Psychological ‘One measure of poor mental health, which can be described as feelings
distress of tiredness, anxiety, nervousness, hopelessness, depression and
sadness.’43 This is consistent with the definition accepted by the National
Mental Health Commission.

Public specialist Services that provide both clinical and non-clinical mental health
mental health services. These are largely delivered by area mental health services
services operated by 17 public health services in Victoria.

Quality A range of strategies, including regulation, used to provide assurance

assurance that services are meeting minimum quality or safety standards and
expectations.

Quality and Monitoring either system or service performance to identify and report
safety oversight on the quality and safety of mental health treatment, care and support.
This can include oversight of specific practices (such as monitoring the
use of electroconvulsive treatment), of the performance of an individual
service, or of the whole system. Oversight often involves a degree of
independence from the practice or service that is subject to oversight.

Recovery- Practice that supports people to autonomously build and maintain a self-
oriented practice defined, meaningful and satisfying life and personal identity, whether or
not there are ongoing symptoms of mental illness.44

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Term Description

Reflective Interprofessional and collaborative group-directed processes of learning

practice through and from experience to gain new insights via:

• reflection on experiences of delivering care, treatment and support

to consumers, families, carers and supporters
• examining and critically reflecting on assumptions underlying
everyday practices
• reflecting on challenging interpersonal dynamics.

Regional Mental Skills-based boards (rather than a representative board) recommended

Health and by the Commission that will include people with lived experience.
Wellbeing Boards
Regional Boards will seek to support communities to achieve the highest
attainable standard of mental health and wellbeing through achieving
the following objectives:

• Services respond to the needs of local communities.

• Services respond to individual needs and preferences, with a focus
on community-based service provision.
• Services are integrated.
• Safe services are incentivised.
• Resources are allocated to improve outcomes.
• Resources are allocated in a way that maximises value.

Regional Boards will have a range of responsibilities. This includes being

responsible for understanding need and planning services, supporting
collaboration, funding and monitoring service providers, workforce
planning and engaging with communities.

Regional New coordinating structures recommended by the Commission in

Multiagency each region to bring together different service providers to support
Panels collaboration and accountability in providing services to consumers by
multiple service agencies.

Restrictive May include ‘bodily restraint’, which is defined as a form of physical or

interventions mechanical restraint that prevents a person from having free movement
of their limbs (excluding the use of furniture), or ‘seclusion’, which is the
sole confinement of a person to a room or any other enclosed space from
where the person is not free to leave.45

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Royal Commission into Victoria’s Mental Health System

Term Description

Seclusion and The Mental Health Act 2014 (Vic) currently defines two forms of ‘restrictive
restraint interventions’:

• Bodily restraint is a form of physical or mechanical restraint that

prevents a person having free movement of their arms or limbs
but does not include the use of furniture (including beds with cot
sides and chairs with tables fitted on their arms) that restricts the
person’s ability to get off the furniture.46
• Seclusion is the sole confinement of a person to a room or any
other enclosed space from which it is not within the control of the
person confined to leave.47

Under the Act, seclusion and restraint can only be used in designated
mental health services.48

The Act also prescribes that restrictive interventions (including seclusion

and restraint) may only be used after ‘all reasonable and less restrictive
options have been tried or considered and have been found to be
unsuitable’.49

Restrictive interventions can also be called ‘restrictive practices’. This

term is used throughout the report when necessary to reflect the use of
the term in source data or evidence.

Secondary care Health services that require a referral from a primary care provider
(usually a GP). A common example is a referral from a GP to a private
psychologist under the Better Access scheme. Another common form of
secondary care is where a GP refers a consumer to a psychiatrist for a
mental health assessment.

Secondary A discussion between mental health clinicians about a particular

consultation consumer. This can enable different care providers to work
collaboratively to discuss issues with the consumer’s care. Other models
of secondary consultation focus on the needs of consumers more
generally—for example, consumers with particular mental health needs
or a specific diagnosis. This model focuses on sharing knowledge and
expertise between different care providers.

Secure extended A unit offering secure services on a general hospital site for people who
care unit need a high level of secure and intensive clinical treatment for severe
mental illness.

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Term Description

Security patient A prisoner who is placed on an order under the Mental Health Act 2014
(Vic) or the Sentencing Act 1991 (Vic) and detained at a designated
mental health service (usually at Forensicare’s Thomas Embling
Hospital).50

Self- In a collective sense, this term is used to refer to the ‘ability of Aboriginal
determination peoples to freely determine their own political, economic, social and
cultural development as an essential approach to overcoming Indigenous
disadvantage’.51

Some materials referenced by the Commission also use the term ‘self-
determination’ to refer to individual autonomy and each person’s ability
to make choices about themselves and their life.

Service and A plan that ‘identifies present and, as best as possible, future demand
capital plan for services’ and is intended to ‘guide the future allocation of resources’.52
Also called a ‘service and infrastructure plan’.

Service The Commission has developed service standards to assist the Victorian
standards Government and Regional Mental Health and Wellbeing Boards to
select service providers—including new providers, such as consumer-
led providers—with adequate capacity and capability to deliver mental
health services. Refer to Chapter 28: Commissioning for responsive
services for detail.

Shared care A structured approach between two or more health services that each
take responsibility for particular aspects of a consumer’s care. This
responsibility may relate to the particular expertise of the health service.
Shared care is supported by formal arrangements, including clear care
pathways and clinical governance, and all health services involved share
a joint and coordinated approach to the health and wellbeing of the
consumer. Shared care approaches can also benefit health providers—
for example, by providing them with access to expert advice, which can
increase their capabilities over time.

Social and Being resilient, being and feeling culturally safe and connected, having
emotional and realising aspirations, and being satisfied with life. This is consistent
wellbeing with Balit Murrup, Victoria’s Aboriginal social and emotional wellbeing
framework.

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Royal Commission into Victoria’s Mental Health System

Term Description

Social A person’s mental health and many common mental illnesses are shaped
determinants of by social, economic, and physical environments, often termed the ‘social
mental health determinants of mental health’. Risk factors for many common mental
illnesses are heavily associated with social inequalities, whereby the
greater the inequality the higher the inequality in risk.53

Social housing Term covering two distinct forms of subsidised rental housing: public
housing, which is owned and operated by the Victorian Government, and
community housing, which is owned and operated by community housing
providers.54

Statewide Based on the evidence presented, the Commission characterises

services statewide services as those that usually involve:

• a workforce with a high level of expertise and knowledge

• a dedicated research focus
• the provision of treatment, care and support to a proportionately
small number of people, often with higher levels of needs.

Stigma The World Health Organization defines stigma as a ‘mark of shame,

disgrace or disapproval which results in an individual being rejected,
discriminated against, and excluded from participating in a number of
different areas of society’.55 Stigma is a fundamentally social process—
different characteristics or traits are not inherently negative, ‘rather,
through a complex social process, they become defined and treated as
such’.56 This process leads to social exclusion.57

Structural Refers to the ‘societal-level conditions, cultural norms, and institutional

stigma practices that constrain the opportunities, resources, and wellbeing for
stigmatised populations’.58

Substance use or Substance use means the use of alcohol, tobacco or other drugs
addiction (prescription or illicit). Substance use may become harmful to a person’s
health and wellbeing or can have other impacts on someone’s life or that
of their family and broader social network.

Addiction to substances means compulsive substance use that is outside

a person’s control, even when it has harmful effects on that person or
their family.

Substituted Where a third party makes treatment decisions for the consumer.
decision making

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Term Description

Supported The process that supports a person to make and communicate decisions
decision making with respect to personal or legal matters. This may be achieved by
offering consumers access to a variety of tools and resources such as
non-legal advocates and peer workers.59

Systemic Term that ‘describes patterns or practices of discrimination that are the
discrimination result of interrelated policies, practices and attitudes that are entrenched
in organisations or in broader society’.60

Telehealth Video teleconferencing using some form of online software or phone-

conferencing to deliver services and supports directly to a consumer.61

Temporary An order made under the Mental Health Act 2014 (Vic) by an authorised
Treatment Order psychiatrist following an examination under an Assessment Order that
requires a person to be provided with compulsory treatment. The order
is either an Inpatient Temporary Treatment Order or a Community
Temporary Treatment Order.62

Tertiary care Highly specialised medical care usually over an extended period of
services time that involves advanced and complex procedures and treatments
performed by medical specialists in state-of-the-art facilities.

Treatment When ‘a person receives treatment for mental illness if things are done
in the course of the exercise of professional skills to remedy the person’s
mental illness; or to alleviate the symptoms and reduce the ill effects of
the person’s mental illness’.63

Treatment, care The Commission uses this phrase consistently with its letters patent.
and support This phrase has also been a deliberate choice throughout this report
to present treatment, care and support as fully integrated, equal parts
of the way people will be supported in the future mental health and
wellbeing system. In particular, wellbeing supports (previously known
at ‘psychosocial supports’) that focus on rehabilitation, wellbeing
and community participation will sit within the core functions of the
future system.

Treatment Order An order made under the Mental Health Act 2014 (Vic) by the Mental
Health Tribunal following a period of treatment under a Temporary
Treatment Order that requires a person to be provided with compulsory
treatment. The order is either an Inpatient Treatment Order or a
Community Treatment Order.64

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Royal Commission into Victoria’s Mental Health System

Term Description

Value-based Care whose goal is to create more value for consumers by focusing on
care the outcomes that matter to them, rather than just focusing on cost-
efficiency. Some funding approaches are designed to encourage greater
value, such as bundled payments.65

Voluntary A person who receives treatment for a mental illness or psychological

patient distress who is not subject to a compulsory assessment or
treatment order.

Wellbeing Used to describe supports for wellbeing in the future system. Includes
supports supports currently known as ‘psychosocial supports’.

Whole of Although there is no universally agreed definition of ‘whole-of-

government government’ approaches (often interchangeably referred to as ‘joined-
up’ approaches), the Commission uses this phrase to denote different
areas of government (for example, health, human services, justice and
corrections) working together to achieve shared outcomes.66

Whole of system The Commission’s terms of reference define the mental health system
by reference to mental health services that are funded wholly, or in
part, by the Victorian Government. When the Commission refers to
‘whole of system’ in relation to the mental health system, the reference
is to a broader system. This includes not only public sector bodies and
organisations at the federal, state and local government levels; it includes
all people and organisations who participate in—or are connected
with—the new mental health and wellbeing system recommended by the
Commission.

Youth Area Future services that will provide tertiary-level, high-intensity and complex
Mental Health support responses via multidisciplinary teams to people aged 12–25
and Wellbeing years. Youth Area Mental Health and Wellbeing Services are a service
Services stream of the 13 Infant, Child and Youth Area Mental Health Services.

Youth Area Mental Health and Wellbeing Services will deliver all the core
functions of community-based mental health services for those requiring
a higher intensity of treatment, care and support than can be provided
through local services or in partnership with them.

Infant, Child and Youth Area Mental Health Services will be delivered
through a partnership between a public health service (or public hospital)
and a non-government organisation that delivers wellbeing supports.

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Volume 5 Glossary

Term Description

Youth Local Future services that will deliver treatment, care and support to people
Mental Health aged 12–25 years or older.
and Wellbeing
Services The role of Youth Local Mental Health and Wellbeing Services in the youth
mental health and wellbeing service stream will be predominantly played
by the network of headspaces across Victoria, although, over time, other
providers may also choose to deliver this level of service.

Youth Local Mental Health and Wellbeing Services and Youth Area Mental
Health and Wellbeing Services will be formally networked within each of
the 13 areas. They will work together in partnerships to provide treatment,
care and support to young people.

Youth mental Future service stream that will provide treatment, care and support to
health and Victorians aged 12–25 years. It is one service stream within the broader
wellbeing service infant, child and youth mental health and wellbeing system.
stream
The Commission has taken an expansive view of what makes up this
service stream, beyond mental health and wellbeing services. The service
stream can be considered to span six levels, where the top level engages
with the most people and each subsequent level supports a decreasing
proportion of the population. The six levels are:

• families, carers and supporters, informal supports, virtual

communities and communities of place, identity and interest
• a broad range of government and community services
• primary and secondary mental health and related services
• Youth Local Mental Health and Wellbeing Services
• Youth Area Mental Health and Wellbeing Services within Infant,
Child and Youth Area Mental Health Services
• statewide services.

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Royal Commission into Victoria’s Mental Health System

Shortened forms
The following shortened forms are frequently used in this report. Other shortened forms are
explained where they are used.

Form Description
AC Companion of the Order of Australia

AM Member of the Order of Australia

AO Officer of the Order of Australia

CEO Chief Executive Officer

DNA deoxyribonucleic acid

GP general practitioner

IT information technology

LGBTIQ+ lesbian, gay, bisexual, trans and gender diverse, intersex, queer and questioning

MP Member of Parliament

OAM Medal of the Order of Australia

PSM Public Service Medal

TAFE Technical and Further Education

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Volume 5 Glossary

1 National Aboriginal Community Controlled Health Organisation, Submission to the Productivity Commission
Inquiry into Human Services: Identifying Sectors for Reform, 2016, p. 4.
2 Victorian Government, Victorian Aboriginal Affairs Framework: 2018–2023, 2018, p. 1.
3 Department of Health and Human Services, Clinical Mental Health Funding Reform: Building a Stronger
Foundation for Funding Adequacy, Growth and Fairness, 2020, p. 3.
4 Australian Institute of Health and Welfare, Mental Health Services in Australia 2004–05, 2007.
5 Mental Health Act 2014 (Vic), sec. 28.
6 Mental Health Act 2014 (Vic), sec. 150.
7 Doris Erbe and others, ‘Blending Face-to-Face and Internet-Based Interventions for the Treatment of Mental
Disorders in Adults: Systematic Review’, Journal of Medical Internet Research, 19.9 (2017), 1–15 (p. 2).
8 Michael E Porter and Robert S Kaplan, How Should We Pay for Health Care? Working Paper 15-041, 2015, p. 3.
9 Carers Recognition Act 2012 (Vic), sec. 3.
10 Carers Recognition Act 2012 (Vic), sec. 3.
11 Department of Health and Human Services, Targeting Zero: Supporting the Victorian Hospital System to Eliminate
Avoidable Harm and Strengthen Quality of Care. Report of the Review of Hospital Safety and Quality Assurance in
Victoria, 2016, p. 3.
12 Karen Gardner and others, ‘A Rapid Review of the Impact of Commissioning on Service Use, Quality, Outcomes and
Value for Money: Implications for Australian Policy’, Australian Journal of Primary Health, 22.1 (2016), 40–49 (p. 40);
Productivity Commission, Introducing Competition and Informed User Choice into Human Services: Reforms to
Human Services, Inquiry Report, 2017, p. 21.
13 Helen Dickinson and others, ‘Making Sense of Joint Commissioning: Three Discourses of Prevention, Empowerment
and Efficiency’, BMC Health Services Research, 13.S6 (2013), p. 1.
14 Royal Commission into Victoria’s Mental Health System, Interim Report, 2019, p. 615.
15 Australian Institute of Health and Welfare, State and Territory Community Mental Health Care Services, 2019, p. 15;
Productivity Commission, Mental Health Inquiry Report, Volume 2, 2020, p. 570.
16 Note: Where there is a gap of no more than five minutes between the orders.
17 Kathryn Williams and others, Patient-Reported Outcome Measures: Literature Review (Australian Commission on
Safety and Quality in Health Care, 2016), pp. 1 and 18.
18 Cath Roper, Flick Grey and Emma Cadogan, Co-Production: Putting Principles into Practice in Mental Health
Contexts, 2018, p. 2.
19 Pet Dudgeon, Helen Milroy and Roz Walker (eds.), Working Together: Aboriginal and Torres Strait Islander Mental
Health and Wellbeing, Second Edition (Canberra: Commonwealth of Australia, 2014), p. 544.
20 Health Services Act 1988 (Vic), sec. 3. Note: the reference to a health service includes a public hospital, public
health service, denomination hospital, privately-operated hospital or private hospital within the meaning of the
Health Services Act 1988 (Vic).
21 Mental Health Act 2014 (Vic), sec. 3.
22 Ana Hategan, Caroline Giroux and James A. Bourgeois, ‘Digital Technology Adoption in Psychiatric Care: An
Overview of the Contemporary Shift from Technology to Opportunity’, Journal of Technology in Behavioral Science,
4 (2019), 171–77 (p. 171).
23 Equal Opportunity Act 2010 (Vic) secs. 4 and 6. The Commission recognises that terms such as ’psychological
disease or disorder’ can be pathologising and stigmatising.
24 Equal Opportunity Act 2010 (Vic), sec. 9.
25 Equal Opportunity Act 2010 (Vic), sec. 10.
26 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 35.
27 Mental Health Act 2014 (Vic), sec. 3.
28 Porter and Kaplan, p. 2.
29 Mental Health Act 2014 (Vic), sec. 305.
30 Centers for Disease Control and Prevention, United States, Indicators: CDC Approach to Evaluation, <www.cdc.gov/
eval/indicators/index.htm>, [accessed 3 December 2020].
31 Royal Commission into Victoria’s Mental Health System, Interim Report, p. 50; Family Safety Victoria, Everybody
Matters: Inclusion and Equity Statement, 2018.
32 Mental Health Act 2014 (Vic), sec. 153.
33 Mental Health Act 2014 (Vic), sec. 4.
34 Mental Health Act 2014 (Vic), sec. 3.
35 Mental Health Act 2014 (Vic), sec. 24.

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36 Peter C Smith, Elias Mossialos and Irene Papanicolas, Performance Measurement for Health System Improvement:
Experiences, Challenges and Prospects (World Health Organization, 2008), p. 4.
37 Smith, Mossialos and Papanicolas, p. 4.
38 Department of Treasury and Finance, Performance Management Framework: For Victorian Government
Departments March 2016, 2017, p. 18.
39 Witness Statement of David Martine PSM, 28 June 2019, para. 17.
40 Department of Treasury and Finance, p. 12.
41 Witness Statement of David Martine PSM, para. 17.
42 PHN Eastern Melbourne, Mental Health, AOD and Suicide Prevention, <www.emphn.org.au/what-we-do/mental-
health>, [accessed 24 October 2019].
43 National Mental Health Commission, Monitoring Mental Health and Suicide Prevention Reform: National Report
2019, 2019, p. 87.
44 Department of Health, Victoria, Framework for Recovery-Oriented Practice, 2011, p. 2; Geoff Shepherd, Jed
Boardman and Mike Slade, Making Recovery a Reality Policy Paper, 2008, p. 2.
45 Mental Health Act 2014 (Vic), sec. 3.
46 Mental Health Act 2014 (Vic), sec. 3.
47 Mental Health Act 2014 (Vic), sec. 3.
48 Mental Health Act 2014 (Vic), secs. 105, 110 and 113.
49 Mental Health Act 2014 (Vic), sec. 105.
50 Mental Health Act 2014 (Vic), sec. 3.
51 Dudgeon, Milroy and Walker, p. 548.
52 Douglas G Travis, Travis Review: Increasing the Capacity of the Victorian Public Hospital System for Better Patient
Outcomes, 2015, pp. 1 and 39.
53 World Health Organization and the Calouste Gulbenkian Foundation, Social Determinants of Mental Health, p.
43, <www.who.int/mental_health/publications/gulbenkian_paper_social_determinants_of_mental_health/en/>,
[accessed 4 December 2020].
54 Victorian Auditor-General’s Office, Managing Victoria’s Public Housing, 2017, p. vii.
55 Witness Statement of Associate Professor Nicola Reavley, 3 July 2019, para. 8; World Health Organization, The
World Health Report 2001. Mental Health: New Understanding, New Hope, 2001, p. 16.
56 James D Livingston, Mental Illness-Related Structural Stigma: The Downward Spiral of Systemic Exclusion Final
Report, 2013, p. 6.
57 Mark L. Hatzenbuehler, Jo C. Phelan and Bruce G. Link, ‘Stigma as a Fundamental Cause of Population Health
Inequalities’, American Journal of Public Health, 103.5 (2013), 813–821 (p. 817).
58 Mark L. Hatzenbuehler and Bruce G. Link, ‘Introduction to the Special Issue on Structural Stigma and Health’, Social
Science and Medicine, 103 (2014), 1–6.
59 M. B. Simmons and P. M. Gooding, ‘Spot the Difference: Shared Decision-Making and Supported Decision-Making
in Mental Health’, Irish Journal of Psychological Medicine, 34.4 (2017), 1–12 (p. 5); General Assembly, United Nations,
Annual Report of the United Nations High Commissioner for Human Rights and Reports of the Office of the High
Commissioner and the Secretary-General, Human Rights Council, Tenth Session, Agenda Item 2, 26 January
2009, p. 15.
60 Department of Justice, An Equality Act for a Fairer Victoria: Equal Opportunity Review Final Report, 2008, p. 7.
61 Mental Health Commission of Canada, Toolkit for E-Mental Health Implementation, 2018, p. 12.
62 Mental Health Act 2014 (Vic), sec. 45.
63 Mental Health Act 2014 (Vic), sec. 6.
64 Mental Health Act 2014 (Vic), sec. 52.
65 Dr Shalika Hegde and Dr Rebecca Haddock, Re-Orienting Funding from Volume to Value in Public Dental Health
Services, Issues Brief No. 32, 2019, p. 44.
66 State Services Authority Victoria, Joined up Government: A Review of National and International Experiences
Working Paper No. 1, 2007, p. 2.

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